US9668768B2 - Intelligent positioning system and methods therefore - Google Patents

Intelligent positioning system and methods therefore Download PDF

Info

Publication number
US9668768B2
US9668768B2 US14/655,872 US201414655872A US9668768B2 US 9668768 B2 US9668768 B2 US 9668768B2 US 201414655872 A US201414655872 A US 201414655872A US 9668768 B2 US9668768 B2 US 9668768B2
Authority
US
United States
Prior art keywords
automated arm
automated
arm
end effector
port
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Active
Application number
US14/655,872
Other versions
US20160113728A1 (en
Inventor
Cameron Piron
Michael Wood
Gal Sela
Joshua Richmond
Murugathas Yuwaraj
Stephen McFadyen
Alex Panther
Nishanthan Shanmugaratnam
William Lau
Monroe M. Thomas
Wes Hodges
Simon Alexander
David Gallop
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Synaptive Medical Inc
Original Assignee
Synaptive Medical Barbados Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Synaptive Medical Barbados Inc filed Critical Synaptive Medical Barbados Inc
Priority to US14/655,872 priority Critical patent/US9668768B2/en
Assigned to SYNAPTIVE MEDICAL (BARBADOS) INC. reassignment SYNAPTIVE MEDICAL (BARBADOS) INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: ALEXANDER, SIMON, GALLOP, David, HODGES, Wes, LAU, WILLIAM, MCFADYEN, STEPHEN, PANTHER, Alex, PIRON, CAMERON, RICHMOND, JOSHUA, SELA, GAL, SHANMUGARATNAM06, NISHANTHAN, THOMAS, MONROE M., WOOD, MICHAEL, YUWARAJ, MURUGATHAS
Publication of US20160113728A1 publication Critical patent/US20160113728A1/en
Priority to US15/480,648 priority patent/US11103279B2/en
Application granted granted Critical
Publication of US9668768B2 publication Critical patent/US9668768B2/en
Assigned to Synaptive Medical Inc. reassignment Synaptive Medical Inc. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: SYNAPTIVE MEDICAL (BARBADOS) INC.
Assigned to Synaptive Medical Inc. reassignment Synaptive Medical Inc. CORRECTIVE ASSIGNMENT TO CORRECT THE 16/935440 APPLICATION PREVIOUSLY RECORDED ON REEL 054251 FRAME 0337. ASSIGNOR(S) HEREBY CONFIRMS THE ASSIGNMENT. Assignors: SYNAPTIVE MEDICAL (BARBADOS) INC.
Assigned to ESPRESSO CAPITAL LTD. reassignment ESPRESSO CAPITAL LTD. SECURITY INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: Synaptive Medical Inc.
Active legal-status Critical Current
Anticipated expiration legal-status Critical

Links

Images

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B17/3417Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421Cannulas
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30Surgical robots
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0062Arrangements for scanning
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/06Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B25HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
    • B25JMANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
    • B25J13/00Controls for manipulators
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017Electrical control of surgical instruments
    • A61B2017/00203Electrical control of surgical instruments with speech control or speech recognition
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017Electrical control of surgical instruments
    • A61B2017/00207Electrical control of surgical instruments with hand gesture control or hand gesture recognition
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/107Visualisation of planned trajectories or target regions
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046Tracking techniques
    • A61B2034/2051Electromagnetic tracking systems
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046Tracking techniques
    • A61B2034/2055Optical tracking systems
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37Surgical systems with images on a monitor during operation
    • A61B2090/373Surgical systems with images on a monitor during operation using light, e.g. by using optical scanners
    • A61B2090/3735Optical coherence tomography [OCT]
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3983Reference marker arrangements for use with image guided surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50Supports for surgical instruments, e.g. articulated arms
    • A61B2090/5025Supports for surgical instruments, e.g. articulated arms with a counter-balancing mechanism
    • A61B2090/504Supports for surgical instruments, e.g. articulated arms with a counter-balancing mechanism with a counterweight
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B50/00Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
    • A61B50/10Furniture specially adapted for surgical or diagnostic appliances or instruments
    • A61B50/13Trolleys, e.g. carts
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • GPHYSICS
    • G05CONTROLLING; REGULATING
    • G05BCONTROL OR REGULATING SYSTEMS IN GENERAL; FUNCTIONAL ELEMENTS OF SUCH SYSTEMS; MONITORING OR TESTING ARRANGEMENTS FOR SUCH SYSTEMS OR ELEMENTS
    • G05B2219/00Program-control systems
    • G05B2219/30Nc systems
    • G05B2219/45Nc applications
    • G05B2219/45123Electrogoniometer, neuronavigator, medical robot used by surgeon to operate

Definitions

  • the present disclosure relates to mechanically assisted positioning of medical devices during medical procedures.
  • Intracranial surgical procedures present new treatment opportunities with the potential for significant improvements in patient outcomes.
  • many existing optical imaging devices and modalities are incompatible due a number of reasons, including, for example, poor imaging sensor field of view, magnification, and resolution, poor alignment of the imaging device with the access port view, a lack of tracking of the access port, problems associated with glare, the presences of excessive fluids (e.g. blood or cranial spinal fluid) and/or occlusion of view by fluids.
  • attempts to use currently available imaging sensors for port-based imaging would result in poor image stabilization.
  • a camera manually aligned to image the access port would be susceptible to misalignment by being regularly knocked, agitated, or otherwise inadvertently moved by personnel, as well as have an inherent settling time associated with vibrations.
  • Optical port-based imaging is further complicated by the need to switch to different fields of view for different stages of the procedure. Additional complexities associated with access port-based optical imaging include the inability to infer dimensions and orientations directly from the video feed.
  • a computer implemented method of adaptively and interoperatively configuring an automated arm used during a medical procedure comprising:
  • the end effector may be an imaging device having a longitudinal axis.
  • the target may be a surgical port having a longitudinal axis.
  • the desired orientation may be such that the longitudinal axis of the imaging device may be colinear with the longitudinal axis of the surgical port.
  • the imaging device may be an external video scope.
  • the desired standoff distance may be between 10 cm and 80 cm.
  • the desired standoff distance may be obtained from a predetermined list.
  • the predetermined list may be related to specific users.
  • the standoff distance may be either increased or decreased responsive to a user command.
  • the user command may be received from one of a foot pedal, a voice command and a gesture.
  • the method may include a user moving the end effector to a position and defining a distance between the end effector and the target as the desired standoff distance.
  • the target may be moved during the medical procedure and the method may include identifying an updated position and orientation of the target, determining an updated new position and orientation for the end effector and moving the end effector to the updated new position and orientation.
  • the updated position and orientation of the target may be obtained continuously and the updated new position and orientation may be determined continuously.
  • the end effector may be moved to the updated new position and orientation responsive to a signal from a user.
  • the signal from the user may be received from a foot pedal.
  • the signal from the user may be one of a voice command and a gesture.
  • the end effector may be moved to the new desired position and orientation responsive to predetermined parameters.
  • the predetermined parameters may be that the target has not moved for more than a particular period of time.
  • the particular period of time may be 15 to 25 seconds.
  • the particular period of time may be defined by a user.
  • the predetermined parameters may be that the orientation may be off co-axial by greater than a predetermined number of degrees.
  • the predetermined number of degrees may be defined by a user.
  • the target may be a port and the predetermined parameters may be less than predetermined percentage of the total field of view of the port. The predetermined percentage may be defined by a user.
  • An intelligent positioning system for adaptively and interoperatively positioning and end effector in relation to a target during a medical procedure including: a automated arm assembly including a multi-joint arm having a distal end connectable to the end effector; a detection system for detecting a position of the target; a control system and associated user interface operably connected to the automated arm assembly and operably connected to the detection system, the control system configured for: identifying a position and an orientation for a target in a predetermined coordinate frame; obtaining a position and an orientation for an end effector on the automated arm assembly, the position and orientation being defined in the predetermined coordinate frame; obtaining a desired standoff distance and a desired orientation between the target and the end effector; determining a new position and a new orientation for the end effector from the position and orientation of the target and the desired standoff distance and the desired orientation; and moving the end effector to the new position and orientation.
  • the system may include a visual display and images from the imaging device may be displayed on the visual display.
  • An automated arm assembly for use with an end effector, a target, a detection system and may be for use during a medical procedure, the automated arm assembly includes: a base frame; a multi-joint arm operably connected to the base frame and having a distal end that may be detachably connectable to the end effector; a weight operably connected to the base frame that provides a counterweight to the multi-joint arm; and a control system operably connected to the multi-joint arm and to the detection system which provide information relating to a position of the target and the control system determines a new position and orientation for the distal end of the multi-joint arm in relation to the position of the target; and whereby the distal end of the multi-joint arm may be moved responsive to information from the control system.
  • the automated arm assembly may include a tower attached to the base frame and extending upwardly therefrom, the multi-joint arm may be attached to the tower and extends outwardly therefrom.
  • the arm may be movably upwardly and downwardly on the tower.
  • the automated arm assembly may include a supporting beam with one end movably attached to the tower and the other end to the automated arm.
  • the multi-joint arm may have at least six degrees of freedom.
  • the automated arm assembly may be moved manually.
  • the base frame may include wheels.
  • the end effector may be tracked using the detection system.
  • the multi-joint arm may include tracking markers which are tracked using the detection system.
  • the automated arm assembly may include a radial arrangement attached to the distal end of the multi-joint arm and the end effector may be movable attached to the radial arrangement whereby the end effector moves along the radial arrangement responsive to information from the control system.
  • the automated arm assembly may include a joy stick operably connected to the control system and movement of the multi-joint arm may be controllable by the joy stick.
  • the end effector may be one of an external video scope, an abrasion laser, a gripper, an insertable probe or a micromanipulator.
  • the end effector may be a first end effector and further including a second end effector attachable proximate to the distal end of the multi-joint arm.
  • the second end effector may be wide angle camera.
  • the control system may constrain the movement of the multi-joint arm based on defined parameters.
  • the defined parameters may include space above patient, floor space, maintaining surgeon line of sight, maintaining tracking camera line of sight, mechanical arm singularity, self-collision avoidance, patient collision avoidance, base orientation, and a combination thereof.
  • the automated arm assembly may include a protective dome attached to the multi-joint arm and the distal end of the multi-joint arm may be constrained to move only within the protective dome.
  • a virtual safety zone may be defined by the control system and the distal end of the multi-joint arm may be constrained to move only within the safety zone.
  • An alignment tool for use with a surgical port including: a tip for insertion into the surgical port; and a generally conical portion at the distal end of the tip and attached such that the conical portion may be spaced outwardly from the end of port when the tip may be fully inserted into the portion.
  • the conical portion may be made of a plurality of circular annotation.
  • a software system includes a user interface for performing surgical procedures, where the user interface includes visualization and processing of images based on tracked devices, and intracranial images (optionally preoperative and intraoperative).
  • the combined result is an efficient imaging and surgical interventional system that maintains the surgeon in a preferred state (e.g. one line of sight, bi-manual manipulation) that is suitable or tailored for performing surgery more effectively.
  • the access port may be employed to provide for an optical visualization path for an imaging device.
  • the imaging device acquires a high resolution image of the surgical area of interest and provides a means for the surgeon to visualize this surgical area of interest using a monitor that displays said image.
  • the image may be still images or video stream.
  • a system in some embodiments, includes an intelligent positioning system, that is interfaced with the navigation system for positioning and aligning one or more imaging devices relative to (and/or within) an access port.
  • tracking devices may be employed to provide spatial positioning and pose information in common coordinate frame on the access port, the imaging device, the automated arm, and optionally other surgically relevant elements such as surgical instruments within the surgical suite.
  • the intelligent positioning system may provide a mechanically robust mounting position configuration for a port-based imaging sensor, and may enable the integration of pre-operative images in a manner that is useful to the surgeon.
  • FIG. 1 is an exemplary embodiment illustrating system components of an exemplary surgical system used in port based surgery
  • FIG. 2 is an exemplary embodiment illustrating various detailed aspects of a port based surgery as seen in FIG. 1 .
  • FIG. 3 is an exemplary embodiment illustrating system components of an exemplary navigation system.
  • FIG. 4A-E are exemplary embodiment of various components in an intelligent positioning system 4 B
  • FIG. 5A-B are exemplary embodiments of an intelligent positioning system including a lifting column.
  • FIG. 6A-C are exemplary embodiments illustrating alignment of an imaging sensor with a target (port).
  • FIG. 7 is an exemplary embodiment of an alignment sequence implemented by the intelligent positioning system.
  • FIG. 8A is a flow chart describing the sequence involved in aligning an automated arm with a target.
  • FIG. 8B is a flow chart describing the sequence involved in aligning an automated arm with a target.
  • FIG. 9A is a flow chart describing the sequence involved in aligning an automated arm with a target.
  • FIG. 9B an illustration depicting a visual cue system for assisting a user in manually aligning an automated arm.
  • FIG. 10A-B is an illustration depicting tool characteristics that can be utilized in optical detection methods.
  • FIG. 11 is a flow chart describing the sequence involved in an embodiment for determining the zero position and desired position of the end effector
  • FIG. 12A-B are exemplary embodiments illustration alignment of an access port in multiple views.
  • FIG. 13 an illustration depicting port characteristics that can be utilized in optical detection methods.
  • FIG. 14A-B are block diagrams showing an exemplary navigation system including an intelligent positioning system.
  • FIG. 15 is a flow chart describing the steps of a port based surgical procedure.
  • FIG. 16A-D are exemplary embodiments illustrating a port with introducer during cannulation into the brain.
  • the terms, “comprises” and “comprising” are to be construed as being inclusive and open ended, and not exclusive. Specifically, when used in the specification and claims, the terms, “comprises” and “comprising” and variations thereof mean the specified features, steps or components are included. These terms are not to be interpreted to exclude the presence of other features, steps or components.
  • exemplary means “serving as an example, instance, or illustration,” and should not be construed as preferred or advantageous over other configurations disclosed herein.
  • the terms “about” and “approximately” are meant to cover variations that may exist in the upper and lower limits of the ranges of values, such as variations in properties, parameters, and dimensions. In one non-limiting example, the terms “about” and “approximately” mean plus or minus 10 percent or less.
  • vigation system refers to a surgical operating platform which includes within it an Intelligent Positioning System as described within this document.
  • Imaging sensor refers to an imaging system which may or may not include within it an Illumination source for acquiring the images.
  • tracking system refers to a registration apparatus including an operating platform which may be included as part of or independent of the intelligent positioning system which.
  • port 100 comprises of a cylindrical assembly formed of an outer sheath.
  • Port 100 may accommodate introducer 1600 which is an internal cylinder that slidably engages the internal surface of port 100 .
  • Introducer 1600 may have a distal end in the form of a conical atraumatic tip to allow for insertion into the sulci folds 1630 of the brain.
  • Port 100 has a sufficient diameter to enable manual manipulation of traditional surgical instruments such as suctioning devices, scissors, scalpels, and cutting devices as examples.
  • FIG. 16B shows an exemplary embodiment where surgical instrument 1612 is inserted down port 100 .
  • FIG. 1 is a diagram illustrating components of an exemplary surgical system used in port based surgery.
  • FIG. 1 illustrates a navigation system 200 having an equipment tower 101 , tracking system 113 , display 111 , an intelligent positioning system 250 and tracking markers 206 used to tracked instruments or an access port 100 .
  • Tracking system 113 may also be considered an optical tracking device or tracking camera.
  • a surgeon 201 is performing a tumor resection through a port 100 , using an imaging device 104 to view down the port at a suffcient magnification to enable enhanced visibility of the instruments and tissue.
  • the imaging device 104 may be an external scope, videoscope, wide field camera, or an alternate image capturing device.
  • the imaging sensor view is depicted on the visual display 111 which surgeon 201 uses for navigating the port's distal end through the anatomical region of interest.
  • An intelligent positioning system 250 comprising an automated arm 102 , a lifting column 115 and an end effector 104 , is placed in proximity to patient 202 .
  • Lifting column 115 is connected to a frame of intelligent positioning system 250 .
  • the proximal end of automated mechanical arm 102 (further known as automated arm herein) is connected to lifting column 115 .
  • automated arm 102 may be connected to a horizontal beam 511 as seen in FIG. 5A , which is then either connected to lifting column 115 or the frame of the intelligent positioning system 250 directly.
  • Automated arm 102 may have multiple joints to enable 5, 6 or 7 degrees of freedom.
  • End effector 104 is attached to the distal end of automated arm 102 .
  • End effector 104 may accommodate a plurality of instruments or tools that may assist surgeon 201 in his procedure.
  • End effector 104 is shown as an external scope, however it should be noted that this is merely an example embodiment and alternate devices may be used as the end effector 104 such as a wide field camera 256 (shown in FIG. 2 ), microscope and OCT (Optical Coherence Tomography) or other imaging instruments.
  • multiple end effectors may be attached to the distal end of automated arm 102 , and thus assist the surgeon in switching between multiple modalities.
  • the surgeon may want the ability to move between microscope, and OCT with stand-off optics.
  • the ability to attach a second more accurate, but smaller range end effector such as a laser based ablation system with micro-control may be contemplated.
  • the intelligent positioning system 250 receives as input the spatial position and pose data of the automated arm 102 and target (for example the port 100 ) as determined by tracking system 113 by detection of the tracking markers 246 on the wide field camera 256 on port 100 as shown in FIG. 2 . Further, it should be noted that the tracking markers 246 may be used to track both the automated arm 102 as well as the end effector 104 either collectively (together) or independently. It should be noted that the wide field camera 256 is shown in this image and that it is connected to the external scope 266 and the two imaging devices together form the end effector 104 . It should additionally be noted that although these are depicted together for illustration of the diagram that either could be utilized independent of the other, for example as shown in FIG. 5A where an external video scope 521 is depicted independent of the wide field camera.
  • Intelligent positioninng system 250 computes the desired joint positions for automated arm 102 so as to maneuver the end effector 104 mounted on the automated arm's distal end to a predetermined spatial position and pose relative to the port 100 .
  • This redetermined relative spatial position and pose is termed the “Zero Position” and is described in further detail below and is shown in FIG. 6A-B where the imaging sensor and port are axially alligned 675 having a linear line of sight.
  • Intelligent positioning system 250 may also include foot pedal 155 for use by the surgeon 201 to align of the end effector 104 (i.e., a videoscope) of automated arm 102 with the port 100 . Foot pedal 155 is also found in FIGS. 5A, 5C and 7 .
  • FIG. 3 is a diagram illustrating system components of an exemplary navigation system for port-based surgery.
  • the main components to support minimally invasive access port-based surgery are presented as separated units.
  • FIG. 1 shows an example system including a monitor 111 for displaying a video image, an optical equipment tower 101 , which provides an illumination source, camera electronics and video storage equipment, an automated arm 102 , which supports an imaging sensor 104 .
  • a patient's brain is held in place by a head holder 117 , and inserted into the head is an access port 100 and introducer 1600 as shown in FIG. 16A .
  • the introducer 1600 may be replaced by a tracking probe (with attached tracking marker 116 ) or a relevant medical instrument such as 1612 used for port-based surgery.
  • the introducer 1600 is tracked using a tracking system 113 , which provides position and orientation information for tracked devices to the intelligent positioning system 250 .
  • FIG. 16D An example of the surgeon dynamically manipulating the port 100 is shown in FIG. 16D .
  • a port based tumor resection is being performed within the brain 1640 .
  • the surgeon 201 will typically maneuver the port 100 to actively search for and provide access to as much of the tumor 120 or equivalently unhealthy tissue as possible in order to resect it using a medical instrument 1612 .
  • FIG. 16C there is a section of the tumor 1680 that is not accessible given the positioning of the port 100 .
  • the surgeon 201 maneuvers the port 100 through a rotation as shown by the dashed arrow 1665 .
  • this maneuvering of the port 100 allows the surgeon 201 to access the previously unaccessible section 1680 of the tumor 120 in order to resect it using the medical instrument 1612 .
  • the method according to the invention described herein is suitable both for an individual automated arm of a multi-arm automated system and for the aforementioned single automated arm system.
  • the gain in valuable operating time, shorter anesthesia time and simpler operation of the device are the direct consequences of the system according to an examplery version of the invention as shown in FIG. 1 .
  • FIGS. 4B and 4C illustrate alternate example embodiments of automated arms.
  • the distal end 408 is positioned using an extended automated arm 102 that extends over the surgeon 201 .
  • the base 428 of this arm 102 may be positioned away from the patient 202 to provide clear access to the patient 202 lying on the surgical bed.
  • the base 428 may be equipped with caster wheel 458 to facilitate mobility within the operating room.
  • a counter weight 438 may be provided to mechanically balance the system and minimize the load on the actuators (this weight serving the same function as weight 532 in FIG. 5B ).
  • the distal end 408 can be arbitrarily positioned due to the presence of a redundant number of degrees of freedom. Joints, such as rotating base 418 in FIG. 4B and joint 448 provide these degrees of freedom.
  • the imaging device 104 may be attached to the final joint or equivalently the distal end 408 .
  • FIG. 4C illustrates another embodiment where a commercially available arm 102 may be used. Again, joints 448 provide redundant number of degrees of freedom to aid in easy movement of the distal end 408 .
  • the distal end may have connectors that can rigidly hold an imaging device while facilitating easy removal of the device to interchange with other imaging devices.
  • FIG. 4D illustrates an alternative embodiment in which a radial arrangement 499 is employed for the distal end. This arrangement allows the end effector to slide along the curved segment 499 to provide a unique degree of freedom.
  • FIGS. 4B-C illustrate a floor-standing design
  • this embodiment is not intended to limit the scope of the disclosure, and it is to be appreciated that other configurations may be employed.
  • alternative example configurations include a structure that is supported from the ceiling of the operating room; a structure extending from a tower intended to encase imaging instrumentation; and by rigidly attaching the base of the automated arm to the surgical table.
  • each distal end may be separately tracked so that the orientation and location of the devices is known to the intelligent positioning system and the position and/or orientation of the mounted distal end devices may be controlled by actuating the individual automated arms based on feedback from the tracking system. This tracking can be performed using any of the methods and devices previously disclosed.
  • the head of the patient may be held in a compliant manner by a second automated arm instead of a rigid frame 117 illustrated in FIG. 1 .
  • the automated head support arm can be equipped with force sensing actuators that provide signals that enable the tracking of minor movement of the head. These sensed position of the head may be provided as feedback to control the relative position of the first automated arm, and correspondingly position the distal end used to mount the device (such as an imaging sensor).
  • This coupling of the head holding assembly and the imaging system may aid in reducing movement artefacts while providing patient comfort. Patient comfort will be greatly enhanced due to the elimination of sharp points used in the traditional head immobilization systems.
  • the space required by the automated arm may be minimized comparatively to presently used surgical arms through the use of a cantilevered design.
  • This design element allows the arm to be suspended over the patient freeing up space around the patient where most automated arms presently occupy during the surgical procedures.
  • FIG. 5( a ) shows such a cantilevered arm 511 , where the arm anchor is a weighted base 512 . This allows the arm to be suspended with minimized risk of tipping, as the weighted base offsets the arm.
  • the space required by the automated arm may be minimized comparatively to presently used surgical arms through the use of a concentrated counterweight 532 attached to the base of the automated arm 512 , which takes up a small footprint not only in its height dimension but as well as the floor area in which it occupies.
  • a concentrated counterweight 532 attached to the base of the automated arm 512 , which takes up a small footprint not only in its height dimension but as well as the floor area in which it occupies.
  • the reduction in area used in the height direction is space that can be occupied by other devices or instruments in the OR such as a surgical tool table.
  • the smaller area required by the base of this automated arm can allow for less restricted movement of personnel around the patient as well as more supplementary device and instruments to be used.
  • FIG. 5B shows such a base which utilizes minimum space and has a concentrated weight 532 .
  • the automated arm in this example is held at a particular height by a lifting column 115 , as this design requires minimal space.
  • some alternate embodiments that could be used for the lifting column 115 include a 4-bar arm, a scissor lift and pneumatic pistons
  • tracking markers 206 may be fitted to port 100 .
  • the spatial position and pose of the port (target) are determined using the tracking markers 206 and are then detected by the tracking device 113 shown in FIG. 1 and registrered within a common coordinate frame.
  • the desired position of the end effector 104 and the automated arm 102 may be determined.
  • lifting column 115 may raise or lower automated arm 102 from an actual position 700 to a desired position 710 .
  • the automated arms spatial position and pose can also be determined using position encoders located in the arm that enable encoding of joint angles. These angles combined with the lengths of the respective arm segments can be used to infer the spatial position and pose of the end effector 104 or equivalently the imaging sensor (for example the exoscope 521 shown in FIG. 5A ) relative to base 512 of intelligent positioning system 250 . Given the automated arms base's 512 spatial position and pose is registered to the common coordinate frame.
  • passive tracking markers such as the reflective spherical markers 206 shown in FIG. 2 are seen by the tracking device 113 to give identifiable points for spatially locating and determining the pose of a tracked object (for example a port 100 or external scope 521 ) to which the tracking markers are connected to.
  • a medical instrument such as port 100 may be tracked by a unique, attached marker assembly 465 which is used to identify the corresponding medical instrument inclusive of its spatial position and pose as well as its 3D volume representation to a navigation system 200 , within the common coordinate frame.
  • Port 100 is rigidly connected to tracking marker assembly 465 which is used to determine its spatial position and pose in 3D.
  • tracking marker assembly 465 which is used to determine its spatial position and pose in 3D.
  • a minimum of 3 spheres are placed on a tracked medical instrument or object to define it.
  • 4 spheres are used to track the target object (port).
  • the navigation system typically utilizes a tracking system. Locating tracking markers is based, for example, on at least three tracking markers 206 that are arranged statically on the target (for example port 100 ) as shown in FIG. 2 on the outside of the patient's body 202 or connected thereto.
  • a tracking device 113 as shown in FIG. 1 detects the tracking markers 206 and determines their spatial position and pose in the operating room which is then registered to the common coordinate frame and subsequently stored by the navigation system.
  • an advantageous feature of an optical tracking device is the selection of markers that can be segmented very easily and therefore detected by the tracking device.
  • markers for example, infrared (IR)-reflecting markers and an IR light source can be used.
  • IR infrared
  • Such an apparatus is known, for example, from tracking devices such as the “Polaris” system available from Northern Digital Inc.
  • the spatial position of the port (target) 100 and the position of the automated arm 102 are determined by optical detection using the tracking device. Once the optical detection occurs the spatial markers are rendered optically visible by the device and their spatial position and pose is transmitted to the intelligent positioning system and to other components of the navigation system.
  • the navigation system or equivalently the intelligent positioning system may utilize reflectosphere markers 206 as shown in FIG. 4E in combination with a tracking device, to determine spatial positioning of the medical instruments within the operating theater.
  • Differentiation of the types of tools and targets and their corresponding virtual geometrically accurate volumes could be determined by the unique individual specific orientation of the reflectospheres relative to one another on a marker assembly 445 . This would give each virtual object an individual identity within the navigation system.
  • These individual identifiers would relay information to the navigation system as to the size and virtual shape of the instruments within the system relative to the location of their respective marker assemblies.
  • the identifier could also provide information such as the tools central point, the tools central axis, etc.
  • the virtual medical instrument may also be determinable from a database of medical instruments provided to the navigation system.
  • tracking markers Other types of tracking markers that could be used would be RF, EM, LED (pulsed and un-pulsed), glass spheres, reflective stickers, unique structures and patterns, where the RF and EM would have specific signatures for the specific tools they would be attached to.
  • the reflective stickers, structures and patterns, glass spheres, and LEDs could all be detected using optical detectors, while RF and EM could be picked up using antennas.
  • Advantages to using EM and RF tags would include removal of the line of sight condition during the operation, where using optical system removes the additional noise from electrical emission and detection systems.
  • printed or 3-D design markers could be used for detection by the imaging sensor provided it has a field of view inclusive of the tracked medical instruments.
  • the printed markers could also be used as a calibration pattern to provide (3-D) distance information to the imaging sensor.
  • These identification markers may include designs such as concentric circles with different ring spacing, and/or different types of bar codes.
  • the contours of known objects i.e., side of the port
  • the contours of known objects could be made recognizable by the optical imaging devices through the tracking system as described in the paper [Lepetit, Vincent, and Pascal Fua. Monocular model - based 3D tracking of rigid objects . Now Publishers Inc, 2005].
  • reflective spheres, or other suitable active or passive tracking markers may be oriented in multiple planes to expand the range of orientations that would be visible to the camera.
  • FIG. 16B shows an access port 100 that has been inserted into the brain, using an introducer 1600 , as previously described.
  • the same access port 100 shown in FIG. 4E includes a plurality of tracking elements 206 as part of a tracking marker assembly 465 .
  • the tracking marker assembly is comprised of a rigid structure 445 to supports the attachment of a plurality of tracking elements 206 .
  • the tracking markers 206 may be of any suitable form to enable tracking as listed above.
  • assembly 465 may be attached to access port 100 , or integrated as part of access port 100 . It is to be understood that the orientation of the tracking markers may be selected to provide suitable tracking over a wide range of relative medical instrument positional orientations and poses, and relative imaging sensor positional orientations and poses.
  • a challenge with automated movement in a potentially crowded space may be the accidental collision of any part of the automated arm with surgical team members or the patient.
  • this may be avoided by partially enclosing the distal end 408 within a transparent or translucent protective dome 645 as shown in FIG. 6A that is intended to prevent accidental contact of the end effector 104 or equivalently the imaging sensor 521 with surgical team members or the patient.
  • the protective dome may be realized in a virtual manner using proximity sensors.
  • a physical dome may be absent but a safety zone 655 around the distal end 408 as shown in FIGS. 6B and 6C may be established.
  • this can be accomplished by using proximity sensor technologies to prevent accidental contact between surgical team members and any moving part of the automated arm with mounted imaging sensor.
  • a further embodiment may include a collision sensor to ensure that the moving automated arm does not collide with any object in the environment. This may be implemented using electrical current sensors, force or velocity sensors and/or defined spatial limits of the automated arm.
  • the safety systems described above are exemplary embodiments of various safety systems that can be utilized in accordance with the intelligent positioning system and should not be interpreted as limiting the scope of this disclosure.
  • the intelligent positioning system is able to acquire the spatial position and pose of the target as well as the automated arm as described above. Having this information the intelligent positioning system can be imposed with a constraint to not position the automated arm within a safety semicircle around the target.
  • a reference marker 611 can be attached to the patient immobilization frame ( 117 ) to provide a reference of the spatial position and pose of the head of the patient, in the common coordinate frame, to the intelligent positioning system through tracking mechanisms described above.
  • r denotes a coordinate of the reference marker and ⁇ , ⁇ , ⁇ , are the degree of roll, pitch, and yaw of the marker.
  • a new reference origin within the common coordinate frame can be defined by assigning the spatial position of the marker to be the origin and the top, left and right sides of the marker (as determined relative to the common coordinate frame by inferring from the acquired roll, pitch, and yaw) to be the z direction, x direction, and y directions relative to the new reference origin within the common coordinate frame.
  • the position of the end effector on the automated arm is defined in spherical coordinates for example (r E , ⁇ E , ⁇ E )
  • a region can be defined in spherical coordinates which can constrain the movement of the end effector to an area 655 outside of which will be defined a “no-fly zone”. This can be achieved by defining an angular range and radial range relative to the reference origin which the end effector cannot cross.
  • An example of such a range is shown as follows: r min ⁇ r E ⁇ r max ⁇ min ⁇ E ⁇ max ⁇ min ⁇ E ⁇ max
  • a safety zone may be established around the surgical team and patient using uniquely identifiable tracking markers that are applied to the surgical team and patient.
  • the tracking markers can be limited to the torso or be dispersed over the body of the surgical team but sufficient in number so that an estimate of the entire body of each individual can be reconstructed using these tracking markers.
  • the accuracy of modelling the torso of the surgical team members and the patient can be further improved through the use of tracking markers that are uniquely coded for each individual and through the use of profile information that is known for each individual similar to the way the tracking assemblies identify their corresponding medical instruments to the intelligent positioning system as described above.
  • Such markers will indicate a “no-fly-zone” that shall not be encroached when the end effector 104 is being aligned to the access port by the intelligent positioning system.
  • the safety zone may be also realized by defining such zones prior to initiating the surgical process using a pointing device and capturing its positions using the navigation system.
  • multiple cameras can be used to visualize the OR in 3D and track the entire automated arm(s) in order to optimize their movement and prevent them from colliding with objects in the OR.
  • Such a system capable of this is described by the paper [System Concept for Collision-Free Robot Assisted Surgery Using Real-Time Sensing”. Jörg Raczkowsky, Philip Nicolai, Björn Hein, and Heinz Wörn. IAS 2, volume 194 of Advances in Intelligent Systems and Computing, page 165-173. Springer, (2012)]
  • Additional constraints on the intelligent positioning system used in a surgical procedure include self-collision avoidance and singularity prevention of the automated arm which will be explained further as follows.
  • the self-collision avoidance can be implemented given the kinematics and sizes of the arm and payload are known to the intelligent positioning system. Therefore it can monitor the joint level encoders to determine if the arm is about to collide with itself. If a collision is imminent, then intelligent positioning system implements a movement restriction on the automated arm and all non-inertial motion is ceased.
  • the arm is unable to overcome a singularity.
  • the intelligent positioning system implements a movement restriction on the automated arm and all non-inertial motion is ceased.
  • an automated arm with six degrees of freedom is provided another degree of freedom by the addition of a lifting column 115 .
  • singularities can be overcome as the restricted motion in one joint can be overcome with the movement of another joint.
  • An end-effector pose is defined by 3 translational and 3 rotational degrees of freedom; to do the inverse kinematics of a 7DOF manipulator requires that you invert a 6 ⁇ 7 matrix, which is not unique. Therefore, while a 7 degree of freedom manipulator allows you to get around singularities due to this non-uniqueness, it is at an additional computational cost. By adding an extra constraint, like the elbow constrained to stay at a particular height, the system would allow a unique solution to be found which would again ease the computational requirement of the system.
  • the automated arm with mounted external scope will automatically move into the zero position (i.e. the predetermined spatial position and pose) relative to the port (target) by the process shown in FIG. 8A .
  • the zero position i.e. the predetermined spatial position and pose
  • the port target
  • the chosen position of the automated arm will align the distal end with mounted external scope, to provide the view of the bottom (distal end) of the port (for port based surgery as described above).
  • the distal end of the port is where the surgical instruments will be operating and thus where the surgical region of interest is located.
  • this alignment can be either manually set by the surgeon or automatically set by the system depending on the surgeons' preference and is termed the “zero position”.
  • the intelligent positioning system will have a predefined alignment for the end effector relative to the port which it will use to align automated arm.
  • FIG. 6A depicts the preferred zero position of the end effector 104 with respect to the port 100 .
  • the relative pose of the imaging device (either the external scope 521 or wide field camera 256 ) is selected such that it guarantees both a coaxial alignment and an offset 675 from the proximal end of the port as shown in both FIGS. 6A-B . More specifically, there ensues a co-axial alignment of the imaging device axis forming, for example, a central longitudinal axis of the imaging device with the longitudinal axis of the port (target) (such as 675 shown in FIGS. 6A-B ) as predefined by the zero position.
  • FIGS. 6A and 6B and described in the prior paragraph are shown supporting an external imaging device having tracking markers 246 attached thereto.
  • a floor mounted arm is shown with a large range manipulator component 685 that positions the end effector of the automated arm (for example, with 6 degrees of freedom), and has a smaller range of motion for the positioning system (for example, with 6 degrees of freedom) mounted on distal end 408 .
  • the distal end of the automated arm 408 refers to the mechanism provided at the distal portion of the automated arm, which can support one or more end effectors 104 (e.g. imaging sensor). The choice of end effector would be dependent on the surgery being performed.
  • FIGS. 6A-B Alignment of the end effector of the automated arm is demonstrated in FIGS. 6A-B .
  • the system detects the motion and responsively repositions the fine position of the automated arm to be co-axial 675 with the access port 100 , as shown in FIG. 6B .
  • the automated arm may maneuver through an arch to define a view that depicts 3D imaging. There are 2 ways to do this— 1 ) is to use two 2D detectors at known positions on the arm, or use one 2D detector and rock back and forth in the view (or move in and out).
  • FIG. 7 is a representation of an alignment sequence implemented by the intelligent positioning system.
  • the automated arm 102 may be moved from its actual position 700 into its desired position 710 with the aid of a cost minimization algorithm or equivalently an error minimization method by the intelligent positioning system 250 .
  • the actual position 700 of the automated arm 102 is acquired continually.
  • the automated arm achieves the desired alignment (zero position) with the target (port 100 ) through movement actuated by the intelligent positioning system.
  • the intelligent positioning system 250 requires the actual position 700 of the arm 102 to approximate the desired position of the arm 710 as depicted by arrow 720 in FIG. 7 . This approximation occurs until the position of the actual arm alignment approximates that of the desired alignment (zero position) within a given tolerance.
  • the automated arm 102 mounted with the imaging device 104 is then in the zero position with respect to the target (port 100 ).
  • the subsequent alignment of the automated arm 102 into the desired position 710 relative to the port 100 may be actuated either continuously or on demand by the surgeon 201 through use of the foot pedal 155 .
  • the cost minimization method applied by the intelligent positioning system is described as follows and depicted in FIG. 8A .
  • visual serving is executed in a manner in which tracking device(s) 113 are used to provide an outer control loop for accurate spatial positioning and pose orientating of the distal end of the automated arm 102 . Where imaging device 104 may be attached.
  • the Intelligent positioning system also utilizes this open control loop to compensate for deficiencies and unknowns in the underlying automated control systems, such as encoder inaccuracy.
  • FIG. 8A is an exemplary flow chart describing the sequence involved in aligning an automated arm with a target using a cost minimization method.
  • the end effectors spatial position and pose is determined, typically in the common coordinate frame, through the use of the tracking device or another method such as the template matching or SIFT techniques described in more detail below.
  • the desired end effector spatial position and pose is determined with the process 1150 shown in FIG. 11 and described further below.
  • the pose error of the end effector as utilized in step ( 830 ), is calculated as the difference between the present end effector spatial position and pose and the desired end effector spatial position and pose and is shown as arrow distance 720 in FIG. 7 .
  • An error threshold as utilized in step ( 840 ) is determined from either the pose error requirements of the end effector or the automated arm limitations. Pose error may include resolution of the joints, minimizing power, or maximizing life expectancy of the motors. If the pose error of the end effector is below the threshold, then no automated arm movement is commanded and the intelligent positioning system waits for the next pose estimation cycle. If the pose error is greater than the threshold the flow chart continues to step ( 850 ) where the end effector error 720 is determined by the intelligent positioning system as a desired movement.
  • the final step ( 860 ) requires the intelligent positioning system to calculate the required motion of each joint of the automated arm 102 and command these movements.
  • the system then repeats the loop and continuously takes new pose estimations from the intelligent positioning system 250 to update the error estimation of the end effector spatial position and pose.
  • the intelligent positioning system can perform the alignment of the automated arm relative to the port optimized for port based surgery using the method as described by the flow chart depicted in FIG. 8B .
  • FIG. 8B describes the method implemented in the flow chart in FIG. 8A in a refined version as used in the port based surgery described above.
  • FIG. 8B an exemplary system diagram is shown illustrating various component interactions for tracking of the access port (target) by the automated arm supporting an imaging device. Tracking and alignment may be triggered manually by the surgeon, or set to track continuously or various other types of automated arm alignment modes as described below in further detail. In both given example modes, the operational flow may be performed as follows:
  • Constant realignment of an end effector with a moving target during a port based surgery is problematic to achieve as the target is moved often and this can result in increased hazard for the equipment and personnel in the surgical suite. Movement artefacts can also induce motion sickness in the surgeons who constantly view the system.
  • the first involves the intelligent positioning system constraining the arm movement so that it only realigns with the target if the target has been in a constant position, different from its initial position, for more than a particular period of time. This would reduce the amount of movement the arm undergoes throughout a surgical procedure as it would restrain the movement of the automated arm to significant and non-accidental movements of the target.
  • Typical duration for maintaining constant position of the target in port based brain surgery is 15 to 25 seconds. This period may vary for other surgical procedures even though the methodology is applicable.
  • Another embodiment may involve estimation of the extent of occlusion of the surgical space due to misalignment of the port relative to the line of sight of the video scope 104 . This may be estimated using tracking information available about the orientation of the port and the orientation of the video scope. Alternatively, extent of occlusion of the surgical space may be estimated using extent of the distal end of the port that is still visible through the video scope. An example limit of acceptable occlusion would be 0-30%.
  • the second embodiment is the actuation mode described herein.
  • Alternate problems with constant realignment of the end effector can be caused by the target as it may not be so steadily placed that it is free of inadvertent minuscule movements that the tracking system will detect. These miniscule movements may cause the automated arm to make small realignments synchronous with small movements of the port. These realignments can be significant as the end effector may be realigning in a radially manner to the port and hence a small movement of the target may be magnified at a stand-off distance (i.e. angular movements of the target at the location of the target may cause large absolute movements of the automated arm located at a radial distance away from the target).
  • a simple way to solve this problem is to have the intelligent positioning system only actuate movement of the arm, if the automated arm's realignment would cause the automated arm to move greater than a threshold amount. For example a movement which was greater than five centimeters in any direction.
  • An alternate method of aligning the port is to use machine vision applications to determine the spatial position and pose of the port from the imaging acquired by the imaging sensor. It should be noted that these techniques (i.e. template matching and SIFT described below) can be used as inputs to step ( 810 ) in the flow chart depicted in FIG. 8A and described in detail above, as opposed to the optical tracking devices described above.
  • the mentioned methods utilize a template matching technique or in an alternate embodiment a SIFT Matching Technique to determine the identity, spatial position, and pose of the target, relative to the end effector mounted on the automated arm.
  • the template matching technique would function by detecting the template located on the target and inferring from its skewed, rotated, translated, and scaled representation in the captured image, its spatial position and pose relative to the imaging sensor.
  • FIGS. 10A and 10B are illustrations depicting target characteristics that can be utilized in optical detection methods.
  • the FIGS. 10A and 10B contain two targets the first being a surgical pointer tool 1015 and the second being a port 100 both having attached templates 1025 and 1030 respectively.
  • the SIFT technique functions by using a known size ratio of two or more recognizable features of a target to analyze an image obtained by an imaging sensor to detect the target.
  • the features could be the inner 1020 and outer circumference 1010 contours of the lip of the port 100 .
  • the SIFT technique uses the features' skewed, rotated, translated, and scaled representation in the analyzed image to infer its spatial position and pose relative to the imaging sensor.
  • both manual and automatic alignment of the automated arm may be achieved using the same mechanism through use of force-sensing joints in the automated arm that would help identify intended direction of motion as indicated by the user (most likely the surgeon and surgical team).
  • the force sensors embedded in the joints can sense the intended direction (e.g. pull or push by the user (i.e. surgical team or surgeon)) and then appropriately energize the actuators attached to the joints to assist in the movement. This will have the distal end moved using powered movement of the joints guided by manual indication of intended direction by the user.
  • the spatial position and pose of the distal end or equivalently the mounted external device may be aligned in two stages.
  • the two alignment stages of the present example implementation include 1) gross alignment that may be performed by the user; 2a) fine positioning that may be performed by the user and assisted by the intelligent positioning system; and/or 2b) fine positioning that is performed by the intelligent positioning system independently.
  • the smaller range of motion described in steps 2a) and more apparently in 2b) is optionally bordered by a virtual ring or barrier, such that as the system operates to align the distal end, the distal end does not move at such a pace as to injure the surgeon, patient or anyone assisting the surgery. This is achieved by constraining the motion of the automated arm to within that small ring or barrier.
  • the ring or barrier may represent the extent of the smaller range of motion of the automated arm controlled by the intelligent positioning system.
  • the user may override this range and the system may re-center on a new location through step 1 as described above, if the larger range of motion of the automated arm controlled by the intelligent positioning system is also automated.
  • An example alignment procedure is illustrated in the flow chart shown in FIG. 9A within the example context of an external imaging device mounted to the automated arm.
  • a user may initially set the gross alignment joints to a neutral position ( 900 ) and wheel it into close proximity of the patient ( 910 ).
  • the intelligent positioning system computes a target end effector spatial position and pose coordinate based on the zero position ( 920 ) that will aim the imaging device coaxially (or in another zero position) relative to the access port 100 , or, for example, at the tip of a surgical pointer tools 1005 and 1015 shown in FIG. 10B .
  • the kinematics engine outputs a set of preferred automated arm joint readings to the user that will achieve the zero position within the tolerance achievable by gross alignment ( 922 ).
  • the user may then employ these readings to manually perform the initial alignment step ( 925 ).
  • the user may choose to manually adjust the coarse positioning by visual feedback alone, or based on a combination of visual feedback and preferred joint readings.
  • the user may manually perform the initial alignment guided by feedback from the system.
  • the system may provide visual and/or audible information indicating to the user the proximity of the alignment of the system to a pre-selected target range or region of the alignment in the common coordinate frame.
  • the feedback provided may assist the user in identifying a suitable gross alignment, for example, by directing the user's alignment efforts.
  • the user may be able to grab the end effector and through a force/torque control loop, guide the end effector into a gross-alignment.
  • This control methodology may also be applied should the surgeon wish to re-orient the external imaging device to be non-coaxial to the access port.
  • the intelligent positioning system may be employed to perform the fine alignment by moving the automated arm such that the imaging device is brought into the exact zero position via any of the algorithms described above and depicted in FIGS. 8A and 8B .
  • the flow chart shown on the right side of FIG. 9A is another exemplary embodiment describing an automated alignment process which can be executed by the intelligent positioning system again analogous to the flow chart depicted in FIG. 8A .
  • the alignment of the imaging device is semi-automated; the actions are performed with operator intervention, and feedback from the intelligent positioning system is performed to provide for the fine and/or final alignment of the external device.
  • the spatial position and pose of the imaging device is tracked, for example, by any of the aforementioned tracking methods, such as through image analysis as described above, or by tracking the position of the access port and imaging sensor using reflective markers, also as described above.
  • the tracked spatial position and pose is employed to provide feedback to the operator during the semi-automated alignment process.
  • a number of example embodiments for providing feedback are presented below. It is to be understood that these embodiments are merely example implementations of feedback methods and that other methods may be employed without departing from the scope of the present embodiment. Furthermore, these and other embodiments may be used in combination or independently.
  • haptic feedback may be provided on the automated arm to help manual positioning of the external device for improved alignment.
  • haptic feedback is providing a tactile click on the automated arm to indicate the position of optimal alignment.
  • haptic feedback can be provided via magnetic or motorized breaks that increase movement resistance when the automated arm is near the desired orientation.
  • a small range of motion can be driven through, for example magnets or motors, which can drive the spatial position and pose of the external device into desired alignment when it is manually positioned to a point near the optimal position. This enables general manual positioning with automated fine adjustment.
  • Another example implementation of providing feedback includes providing an audible, tactile or visual signal that changes relative to the distance to optimal positioning of the access port.
  • two audible signals may be provided that are offset in time relative to the distance from optimal position. As the imaging sensor is moved towards optimal position the signals are perceived to converge. Right at the optimal position a significant perception of convergence is realized.
  • the signal may be periodic in nature, where the frequency of the signal is dependent on the distance from the desired position. It is noted that human auditory acuity is incredibly sensitive and can be used to discriminate very fine changes. See for example: http://phys.org/news/2013-02-human-fourier-uncertainty-principle.html.
  • visual indicators may be provided indicating the direction and amount of movement required to move the imaging sensor into alignment.
  • this can be implemented using light sources such as LEDs positioned on the automated arm, or, for example, a vector indicator on the video display screen of the camera.
  • An example illustration of the vector indicator is shown in FIG. 9B where the arrows 911 , 921 and 931 represent visual indicators to the user performing the manual movement.
  • a shorter arrow 921 represents the spatial position and pose of the imaging device being closer to its required position compared to the longer arrow shown in 911 .
  • steps may be taken to set the relative spatial position and pose of the automated arm (mounted with external device or equivalently an imaging device) with respect to the target in the common coordinate frame. for example, that of manually placing the imaging sensor in a chosen spatial position and pose relative to the target spatial position and pose and defining this position to the intelligent positioning system as a zero (chosen) position relative to the port. Which the imaging sensor and accordingly the automated arm should constantly return to, when prompted by the surgeon or automatically by the intelligent positioning system.
  • the left flow chart 1100 describes how to set the zero position and is described further as follows.
  • the first step 1110 is to position the end effector relative to the target in the desired spatial position and pose (manually). Once this is completed the intelligent positioning system moves to the next step 1120 where it acquires the spatial position and pose of the end effector in the common coordinate frame. In the same step it stores this spatial position and pose as coordinates in the common coordinate frame, for example, shown as follows; (x e ,y e ,z e , ⁇ e , ⁇ e , ⁇ e )
  • step 1130 is the same as the prior step 1120 only that the process is applied to the target.
  • Example coordinates acquired for this step are shown as follows; (x t ,y t ,z t , ⁇ t , ⁇ t , ⁇ t , ⁇ t )
  • the final step 1140 in the flow chart is to subtract the target coordinates from the end effector coordinates to obtain the “Zero Position” coordinates.
  • the “Zero Position” coordinates is a transform that when added to the dynamic target coordinates during surgery can reproduce the relative position of the end effector to the target in the zero position.
  • the right most flow chart 1150 in FIG. 11 describes an example of how the intelligent positioning system determines the desired position of the end effector during a surgical procedure and using the “Zero Position” coordinate.
  • the first step 1160 is to prompt the intelligent positioning system to realign the end effector in the zero position.
  • the next step 1170 is to acquire the spatial position and pose of the target in the common coordinate frame. In the same step it stores this spatial position and pose as coordinates, for example shown as follows; (x t ,y t ,z t , ⁇ t , ⁇ t , ⁇ t )
  • the following step 1180 is to add the “Zero Position” coordinates to the target coordinates to obtain the “desired position of the end effector” coordinates. For example as shown as follows; (x d ,y d ,z d , ⁇ d , ⁇ d , ⁇ d )(x t ,y t ,z t , ⁇ t , ⁇ t , ⁇ t )+(x n ,y n ,z n , ⁇ n , ⁇ n , ⁇ n , ⁇ n )
  • the final step 1190 is to import these coordinates into the common coordinate frame to define to the desired end effector spatial position and pose.
  • an alignment device is rigidly and removably connected to the access port, and may also be employed as an alignment mechanism for use during video-based alignment.
  • FIG. 12B illustrates an example implementation for aligning an access port based on visual feedback in imaging provided by an external imaging device aligned with the desired trajectory of interest.
  • Conical device 1205 is rigidly and removably attached to access port 1230 with its tip 1225 aligned along the axis of the access port with circular annotations 1215 printed at various depths.
  • the circular markers 1215 will appear concentric as shown in FIG. 12B (iii) and (iv).
  • a misaligned access port will result in the circular markers not appearing in concentric fashion.
  • An example of such misalignment is shown in FIG. 12B (ii).
  • a virtual cross-hair 1265 may be displayed on a screen to aid a surgeon to coaxially align the access port while viewing the access port through an externally positioned imaging device.
  • the position of the virtual cross-hair can be based on pre-operative surgical planning and can be the optimal path for inserting the surgical access port for minimizing trauma to the patient.
  • FIG. 12A illustrates another example implementation in which two or more alignment markers 1210 are provided at different depths along the axis of the access port 1230 , optionally with a cross on each alignment marker.
  • These alignment markers can be provided with increasing diameter as the distance increases relative to the imaging device, so that the alignment markers are visible even if partially occluded by nearer alignment markers.
  • the correct alignment would be indicated by an alignment of all the markers within the annotated representation of the markers, as shown in see FIG. 12A (iii) and (iv).
  • the alignment markers can be provided with a colored edge 1240 that if visible on the imaging device feed, would indicate that the alignment is off axis, as shown in FIG. 12A (ii).
  • the video overlay may also include a display of the depth to the target plane so that the insertion distance can be seen by the surgeon on the same screen as the targeting overlay and the video display of the surgical field.
  • the automated arm of the intelligent positioning system will function in various modes as determined but not limited by the surgeon, the system, the phase of surgery, the image acquisition modality being employed, the state of the system, the type of surgery being done (e.g. Port based, open surgery, etc.), the safety system. Further the automated arm may function in a plurality of modes which may include following mode, instrument tracking mode, cannulation mode, optimal viewing mode, actual actuation mode, field of view mode, etc.
  • the automated arm will follow the target at the predetermined (chosen) spatial position and pose as the target is manipulated by the surgeon (for example in the manner illustrated in FIGS. 16C-D and described in detail above), either through electronic or physical means.
  • the surgeon will manipulate the port within the patient's brain as they search for tumor tissue 120 to resect.
  • the automated arm mounted with the imaging device will move to consistently provide a constant field of view down the port with lighting conditions geared towards tissue differentiation.
  • This mode can be employed with restrictions to assure that no contact of the arm is made with any other instrument or personnel including the surgeon within the operating room by the process described in the description of FIG. 6C .
  • This restriction can be achieved using proximity sensors to detect obstacles or scene analysis of images acquired for the operating room as described below in greater detail.
  • surgeon can either dictate the chosen (zero position) spatial position and pose of the arm (including the Imaging device) relative to the target or it can be determined automatically by the system itself through image analysis and navigational information.
  • the automated arm can adjust the imaging device to follow the medical instruments used by the surgeon, by either centering the focus or field of view and any combination thereof on one instrument, the other instrument, or both instruments. This can be accomplished by uniquely identifying each tool and modelling them using specific tracking marker orientations as described above.
  • the automated arm adjusts the imaging device to an angle which provides an improved view for cannulation of the brain using a port. This would effectively display a view of the depth of the port and introducer as it is inserted into the brain to the surgeon
  • an optimal viewing mode can be implemented where an optimal distance can be obtained and used to actuate the automated arm into a better viewing angle or lighting angle to provide maximized field of view, resolution, focus, stability of view, etc. as required by the phase of the surgery or surgeon preference.
  • the determination of these angles and distances within limitations would be provided by a control system within the intelligent positioning system.
  • the control system is able to monitor the light delivery and focus on the required area of interest, given the optical view (imaging provided by the imaging sensor) of the surgical site, it can then use this information in combination with the intelligent positioning system to determine how to adjust the scope to provide the optimal viewing spatial position and pose, which would depend on either the surgeon, the phase of surgery, or the control system itself.
  • actuation mode in which case the surgeon has control of the actuation of the automated arm to align the imaging device with the target in a chosen spatial position and pose and at a pre-set distance. In this way the surgeon can utilize the target (If a physical object) as a pointer to align the imaging device in whatever manner they wish (useful for open surgery) to optimize the surgery which they are undertaking.
  • the automated arm in combination with the imaging device can be made to zoom on a particular area in a field of view of the image displayed on the surgical monitor.
  • the area can be outlined on the display using instruments which would be in the image or through the use of a cursor controlled by a personnel in the operating room or surgeon. Given the surgeon has a means of operating the cursor.
  • Such devices are disclosed in US Patents.
  • the modes mentioned above and additional modes can be chosen or executed by the surgeon or the system or any combination thereof, for example the instrument tracking mode and optimal lighting mode can be actuated when the surgeon begins to use a particular tool as noted by the system.
  • the lighting and tracking properties of the modes can be adjusted and made to be customized to either each tool in use or the phase of the surgery or any combination thereof.
  • the modes can also be employed individually or in any combination thereof for example the Raman mode in addition to the optical view mode. All of the above modes can be optionally executed with customized safety systems to assure minimization of failures during the intra-operative procedure.
  • alignment with the access port may be important for a number of reasons, such as, the ability to provide uniform light delivery and reception of the signal.
  • auto-focus of the camera to a known location at the end of the access port may be required or beneficial.
  • the present embodiments may provide for accurate alignment, light delivery, regional image enhancement and focus for external imaging devices while maintaining an accurate position.
  • Automated alignment and movement may be performed in coordination with tracking of the target (access port). As noted above, this may be accomplished by determining the spatial position and/or pose of the target (access port) by a tracking method as described above, and employing feedback from the tracked spatial position and/or pose of the external imaging device when controlling the relative position and/or pose of the external imaging device using the automated arm.
  • directional illumination device such as a laser pointer or collimated light source (or an illumination source associated with an imaging device supported by the automated arm) may be used to project.
  • a calibration pattern is located at or near the proximal end of the access port. This pattern will allow the camera imaging device to automatically focus, align the orientation of its lens assembly, and optionally balance lighting as well as color according to stored values and individual settings.
  • An exemplary method used to identify the particular type of port being used is the template matching method described above.
  • the template 1030 shown in FIG. 10A can be used to provide the required information about the port dimensions for optimal lighting and focus parameters that the imaging device can be configured to conform with.
  • Another stage of alignment may involve the camera imaging device focusing on the tissue deep within the access port, which is positioned at a known depth (given the length of the access port is known and the distance of the port (based on the template on the proximal end of the port).
  • the location of the distal end of the access port 100 will be at a known position relative to the imaging sensor 104 of FIG. 1 and tracked access port 100 , in absolute terms, with some small-expected deviation of the surface of the tissue bowing into the access port at the distal end.
  • the focus setting can be predetermined in a dynamic manner to enable auto-focus to the end of the tissue based simply on tracking of the access port and camera location, while using some known settings (camera, access port length, focus optics/mechanics, desired field of view). In this manner, a stable focus can be established to maximize the desired field of view.
  • color and white balance of the imaging device output can be determined through suitable imaging processing methods.
  • a significant issue with current surgical optics is glare caused by fluids reflecting the intense illumination in the surgical cavity.
  • the glare causes imbalance in the dynamic range of the camera, where the upper range of the detectors dynamic range is saturated.
  • the illumination intensity across the frequency spectrum can be unbalanced depending on the illumination and surgical conditions.
  • the tracking system can be employed, in a first step of alignment, to track the position of the access port, for a gross calculation of spatial position and pose.
  • This allows for an imaging device 104 , as seen in FIG. 1 , to be positioned in a co-axial manner relative to the port 100 , and at the appropriate focal distance and focal setting based on the field of view, resolution, and frame rate, defined by the user. This will only be accurate within the tolerance of the tracking capability of the system, the mechanical positioning accuracy of the automated arm, and the tissue deflection at the tip of the access port.
  • a second stage alignment can optionally be achieved by interaction of the imaging sensor, positioning of the automated arm, analysis of the images, and the use of range detection to the end of the access port (for example by template matching), and centered at the distal end of the access port.
  • the image can be analyzed to determine the sharpness of the image by way of image metric quantification in a series of focal zones.
  • the focal zones would be directed to a location at the end of the access port, where the gross positioning of the system would allow for this fine, and more focused approach to automatically detect the focal zone as being within the field of view of the end of the access port. More specifically, this is defined as a zone smaller than the field of view of the access port.
  • one or more range detectors can be used, optionally through the lens of the imaging device 104 , so that the actual position of the tissue at the end of the access port can be calculated. This information can be provided as input into the iterative algorithm that determines the optimal imaging device position, and focal settings.
  • the coaxial alignment of the imaging sensor with the access port enables efficient light delivery to the end of the access port which is vital to acquiring higher resolution imaging, as well as the ability to focus optics so as to enhance or maximize the detector efficiency. For instance, with a poorly aligned access port and imaging sensor, only a small fraction of the imaging sensor is utilized for imaging of the area of interest, i.e. the end of the access port. Often only 20% of the total detector is used, while a properly aligned imaging sensor can yield 60%+detector efficiency. An improvement from 20% to 60% detector efficiency roughly yields an improved resolution of 3 times. A setting can be established on the system to define a desired efficiency at all times. To achieve this, the intelligent positioning system will actuate the movement of the automated arm, mounted with the imaging sensor, and focus it at the distal end of the access port as it is maneuvered by the surgeon to achieve the desired detector efficiency, or field of view.
  • the intelligent positioning system can utilize light ray tracing software (such as ZMAX) to model the system given the constraints of the spatial position, pose and 3D virtual model of the port as well as the spatial position, pose and model illumination source as shown in FIG. 13 .
  • the first model 1310 shows the illumination of the region of interest using a single illumination element on the external imaging device at a given distance and pose relative to the port.
  • the second 1320 and third 1330 models show illumination of the region of interest using illumination from two sources each.
  • the pairs of sources in each model are oriented differently with respect to the other model. Both models two and three have the same distance and pose parameters as model one relative to the port.
  • the final model 1340 shows illumination from two sources with the same orientation as the sources in the second model 1320 relative to the imaging device, with the same pose but, a different distance.
  • the color map on each region of interest (distal end of the port) shown in the figure describes the illumination level, where mid-range 1350 represents the ideal illumination level.
  • hot spots 1360 exist in models one through three ( 1310 , 1320 , 1330 ) which result in heavy glare at those positions and inadequate imaging for the surgeon, while model four 1340 provides the optimal lighting condition (homogenized and low glare delivery of illumination).
  • the automated arm would position the imaging sensor (inclusive of the illumination source) to achieve this particular illumination level map thereby improving the view of the surgical area of interest for the surgeon.
  • the software can then determine the optimal spatial position and pose of the illumination source (the Imaging device in this case) relative to the target (port) given the restrictions of the system (minimum offset 575 as shown in FIG.
  • the illumination source may be also optimally positioned after modelling the shadow cast by the surgical tools.
  • the target region within the field of view may be optimally illuminated while avoiding casting of shadows from the medical instruments utilized by the surgeon within the port. This is possible given the spatial position and pose of the medical instrument can be estimated using tracking markers placed on the surgical tools.
  • FIGS. 14A and 14B a block diagram of an example system configuration is shown.
  • the example system includes control and processing system 1400 and a number of external components, shown below.
  • control processing system 1400 may include one or more processors 1402 , a memory 1404 , a system bus 1406 , one or more input/output interfaces 408 , a communications interface 1410 , and storage device 1412 .
  • Processing and control system 1400 is interfaced with a number of external devices and components, including, for example, those associated with access port imaging and tracking, namely motor(s) 1420 , external imaging device(s) 1422 , projection and illumination device(s) 1424 , and automated arm 1426 .
  • External user input and user interface rendering is facilitated by one or more displays 1430 and one or more external input/output devices 1426 (such as, for example, a keyboard, mouse, foot pedal, microphone and speaker).
  • Processing and control system 1400 is also interfaced with an intelligent positioning system 1440 inclusive of a tracking device 113 for tracking items such as an access port 100 in Figure or 1450 in FIG. 14 and one or more devices or instruments 1452 .
  • Additional optional components include one or more therapeutic devices 1442 that may be controlled by processing and control system 1400 , and external storage 1444 , which may be employed, for example, for storing pre-operative image data, surgical plans, and other information.
  • control and processing 1400 may be provided as an external component that is interfaced to a processing device.
  • navigation system 1440 may be integrated directly with control and processing system 1400 .
  • Embodiments of the disclosure can be implemented via processor 1402 and/or memory 1404 .
  • the functionalities described herein can be partially implemented via hardware logic in processor 1402 and partially using the instructions stored in memory 1404 , as one or more processing engines.
  • Example processing engines include, but are not limited to, statics and dynamics modeling engine 1458 , user interface engine 1460 , tracking engine 1462 , motor controller 1464 , computer vision engine 1466 , engine to monitor surrounding environment of the automated arm based on sensor inputs 1431 , image registration engine 1468 , robotic planning engine 1470 , inverse kinematic engine 1472 , and imaging device controllers 1474 . These example processing engines are described in further detail below.
  • Some embodiments may be implemented using processor 1402 without additional instructions stored in memory 1404 . Some embodiments may be implemented using the instructions stored in memory 1404 for execution by one or more general purpose microprocessors. Thus, the disclosure is not limited to a specific configuration of hardware and/or software.
  • At least some aspects disclosed can be embodied, at least in part, in software. That is, the techniques may be carried out in a computer system or other data processing system in response to its processor, such as a microprocessor, executing sequences of instructions contained in a memory, such as ROM, volatile RAM, non-volatile memory, cache or a remote storage device.
  • processor such as a microprocessor
  • a memory such as ROM, volatile RAM, non-volatile memory, cache or a remote storage device.
  • a computer readable storage medium can be used to store software and data which when executed by a data processing system causes the system to perform various methods.
  • the executable software and data may be stored in various places including for example ROM, volatile RAM, nonvolatile memory and/or cache. Portions of this software and/or data may be stored in any one of these storage devices.
  • automated arm need only account for the known weight of external devices (such as imaging devices) attached to the distal end.
  • external devices such as imaging devices
  • known statics and dynamics of the entire automated arm can be modeled a priori (e.g. via engine 1458 of FIG. 14 ) and this knowledge can be incorporated in the accurate control of the arm during tracking.
  • imaging and tracking modalities can be used to provide situational awareness for the automated arm, as described above. This situational knowledge can be incorporated during tracking of the access port by the external device or devise supported by the arm to avoid accidental collision of the arm with obstacles in the path such as surgical team, other equipment in the operating room and the patient. This situational awareness may also arrive from proximity sensors optionally mounted on the automated arm and/or distal end, as noted above.
  • FIG. 14B is an exemplary embodiment of the intelligent positioning system illustration utilized in connection with a navigation system.
  • the descriptions below outline various exemplary communication paths which may be utilized throughout the intelligent positioning system (IPS).
  • the surgeon has three discrete-input pedals to control the IPS:
  • pedals are connected to the digital inputs on the automated arm through the intelligent positioning system 250 .
  • the automated arm controller sends joint-level commands to the motor drivers in the automated arm.
  • foot-pedals may be enhanced to include Optics control as well.
  • the user can interface with the robot through a touch screen monitor. These are generally done prior to surgery.
  • the NDI tracking system acquires the distal end (or equivalently the imaging sensor) spatial position and pose within its field of view. It sends this data to the UI Computer which shares the tracked target and distal end information with the automated arm controller so that the spatial position and pose can be calculated. It may also use the patient reference and registration to determine a no-access zone.
  • the situational awareness camera (specific embodiment of an imaging sensor) provides imaging of the surgical site. This imaging is sent to the UI computer which turns them into a video stream which is output to an external monitor. As well, the UI computer may overlay warnings, error messages or other information for the user on the video stream.
  • FIG. 15 An example phase breakdown of the port based surgical operation is shown in FIG. 15 .
  • the arm can be utilized in a corresponding manner to each of the phases to compliment and ease the surgeons process during each step.
  • the automated arm is maneuvered in a similar manner to the incision step providing the correct view of the surgical area during the suturing of the wound.
  • the intelligent positiong system can be provided with presurgical information to improve arm function.
  • presurgical information examples include a system plan indicating the types of movements and adjustments required for each stage of surgery as well as the operating theater instruments and personnel positioning during the phases of surgery. This would streamline the surgical process by reducing the amount of manual and customized adjustments dictated by the surgeon throughout the procedure.
  • Other information such as the unique weights of the imaging sensors can be inputted to assure a smooth movement of the arm by automatic adjustment of the motors used to run it.
  • ANSI/RIA R15.06-1999 The American National Standard for Industrial Robots and Robot Systems—Safety Requirements (ANSI/RIA R15.06-1999) defines a singularity as “a condition caused by the collinear alignment of two or more robot axes resulting in unpredictable robot motion and velocities.” It is most common in robot arms that utilize a “triple-roll wrist”. This is a wrist about which the three axes of the wrist, controlling yaw, pitch, and roll, all pass through a common point.
  • An example of a wrist singularity is when the path through which the robot is traveling causes the first and third axes of the robot's wrist (i.e. robot's axes 4 and 6 ) to line up.
  • the second wrist axis attempts to spin 360° in zero time to maintain the orientation of the end effector.
  • Another common term for this singularity is a “wrist flip”.
  • the result of a singularity can be quite dramatic and can have adverse effects on the robot arm, the end effector, and the process.
  • Some industrial robot manufacturers have attempted to side-step the situation by slightly altering the robot's path to prevent this condition.
  • Another method is to slow the robot's travel speed, thus reducing the speed required for the wrist to make the transition.
  • the ANSI/RIA has mandated that robot manufacturers shall make the user aware of singularities if they occur while the system is being manually manipulated.
  • a second type of singularity in wrist-partitioned vertically articulated six-axis robots occurs when the wrist center lies on a cylinder that is centered about axis 1 and with radius equal to the distance between axes 1 and 4 . This is called a shoulder singularity.
  • Some robot manufacturers also mention alignment singularities, where axes 1 and 6 become coincident. This is simply a sub-case of shoulder singularities. When the robot passes close to a shoulder singularity, joint 1 spins very fast.
  • the third and last type of singularity in wrist-partitioned vertically articulated six-axis robots occurs when the wrist's center lies in the same plane as axes 2 and 3 .
  • the automated arm be mobile instills another constraint on the intelligent positioning system, which is to ensure the mobile base and the automated arm are not simultaneously in motion at any given time. This is accomplished by the system by having an auto-locking mechanism which applies brakes to the arm if the wheel brakes for the mobile base are not engaged.
  • the reasoning for this constraint is movement of the arm without a static base will result in motion of the base (basic physics). If the arm is mounted on a vertical lifting column, the lifting column adds to this constraint set: the lifting column cannot be activated if the mobile base wheels are not braked or if the arm is in motion. Similarly, the arm cannot be moved if the lifting column is active. If the mobile base wheel brakes are released, the arm and lifting column are both disabled and placed in a braked state.
  • system, devices and methods that employ imaging devices, guidance devices, tracking devices, navigation systems, software systems and surgical tools to enable a fully integrated and minimally invasive surgical approach to performing neurological and other procedures, such as previously inoperable brain tumors, in addition to the intracranial procedure using the port based method described above.
  • neurological and other procedures such as previously inoperable brain tumors
  • the application of the embodiments provided herein is not intended to be limited to neurological procedures, and may be extended to other medical procedures where it is desired to access tissue in a minimally invasive manner, without departing from the scope of the present disclosure.
  • Non-limiting examples of other minimally invasive procedures include colon procedures, spinal, orthopedic, open, and all single-port laparoscopic surgery that require navigation of surgical tools in narrow cavities.

Abstract

System and methods are provided for adaptively and interoperatively configuring an automated arm used during a medical procedure. The automated arm is configured to position and orient an end effector on the automated arm a desired distance and orientation from a target. The end effector may be an external video scope and the target may be a surgical port. The positions and orientations of the end effector and the target may be continuously updated. The position of the arm may be moved to new locations responsive to user commands. The automated arm may include a multi-joint arm attached to a weighted frame. The weighted frame may include a tower and a supporting beam.

Description

This application is a National Phase application claiming the benefit of the International PCT Patent Application No. PCT/CA2014/050271, filed on Mar. 14, 2014, in English, which claims priority to U.S. Provisional Application No. 61/801,530, titled “SYSTEMS, DEVICES AND METHODS FOR PLANNING, IMAGING, AND GUIDANCE OF MINIMALLY INVASIVE SURGICAL PROCEDURES” and filed on Mar. 15, 2013, the entire contents of which are incorporated herein by reference.
This application claims priority to U.S. Provisional Application No. 61/801,530, titled “SYSTEMS, DEVICES AND METHODS FOR PLANNING, IMAGING, AND GUIDANCE OF MINIMALLY INVASIVE SURGICAL PROCEDURES” and filed on Mar. 15, 2013, the entire contents of which is incorporated herein by reference. This application also claims priority to U.S. Provisional Application No. 61/818,280, titled “SYSTEMS, DEVICES AND METHODS FOR PLANNING, IMAGING, AND GUIDANCE OF MINIMALLY INVASIVE SURGICAL PROCEDURES” and filed on May 1, 2013, the entire contents of which is incorporated herein by reference. This application also claims priority to U.S. Provisional Application No. 61/800,695, titled “INSERTABLE MAGNETIC RESONANCE IMAGING COIL PROBE FOR MINIMALLY INVASIVE CORRIDOR-BASED PROCEDURES” and filed on Mar. 15, 2013, the entire contents of which is incorporated herein by reference. This application also claims priority to U.S. Provisional Application No. 61/818,223, titled “IMAGING ASSEMBLY FOR ACCESS PORT-BASED MEDICAL PROCEDURES” and filed on May 1, 2013, the entire contents of which is incorporated herein by reference. This application also claims priority to U.S. Provisional Application No. 61/801,143, titled “INSERTABLE MAGNETIC RESONANCE IMAGING COIL PROBE FOR MINIMALLY INVASIVE CORRIDOR-BASED PROCEDURES” and filed on Mar. 15, 2013, the entire contents of which is incorporated herein by reference. This application also claims priority to U.S. Provisional Application No. 61/818,325, titled “INSERTABLE MAGNETIC RESONANCE IMAGING COIL PROBE FOR MINIMALLY INVASIVE CORRIDOR-BASED PROCEDURES” and filed on May 1, 2013, the entire contents of which is incorporated herein by reference. This application also claims priority to U.S. Provisional Application No. 61/801,746, titled “INSERT IMAGING DEVICE” and filed on Mar. 15, 2013, the entire contents of which is incorporated herein by reference. This application also claims priority to U.S. Provisional Application No. 61/818,255, titled “INSERT IMAGING DEVICE” and filed May 1, 2013, the entire contents of which is incorporated herein by reference. This application also claims priority to U.S. Provisional Application No. 61/800,155, titled “PLANNING, NAVIGATION AND SIMULATION SYSTEMS AND METHODS FOR MINIMALLY INVASIVE THERAPY” and filed Mar. 15, 2013, the entire contents of which is incorporated herein by reference. This application also claims priority to U.S. Provisional Application No. 61/924,993, titled “PLANNING, NAVIGATION AND SIMULATION SYSTEMS AND METHODS FOR MINIMALLY INVASIVE THERAPY” and filed Jan. 8, 2014, the entire contents of which is incorporated herein by reference.
FIELD
The present disclosure relates to mechanically assisted positioning of medical devices during medical procedures.
BACKGROUND
Intracranial surgical procedures present new treatment opportunities with the potential for significant improvements in patient outcomes. In the case of port-based surgical procedures, many existing optical imaging devices and modalities are incompatible due a number of reasons, including, for example, poor imaging sensor field of view, magnification, and resolution, poor alignment of the imaging device with the access port view, a lack of tracking of the access port, problems associated with glare, the presences of excessive fluids (e.g. blood or cranial spinal fluid) and/or occlusion of view by fluids. Furthermore, attempts to use currently available imaging sensors for port-based imaging would result in poor image stabilization. For example, a camera manually aligned to image the access port would be susceptible to misalignment by being regularly knocked, agitated, or otherwise inadvertently moved by personnel, as well as have an inherent settling time associated with vibrations. Optical port-based imaging is further complicated by the need to switch to different fields of view for different stages of the procedure. Additional complexities associated with access port-based optical imaging include the inability to infer dimensions and orientations directly from the video feed.
In the case of port-based procedures, several problems generally preclude or impair the ability to perform port-based navigation in an intraoperative setting. For example, the position of the access port axis relative to a typical tracking device employed by a typical navigation system is a free and uncontrolled parameter that prohibits the determination of access port orientation. Furthermore, the limited access available due to the required equipment for the procedure causes methods of indirect access port tracking to be impractical and unfeasible. Also, the requirement for manipulation of the access port intraoperatively to access many areas within the brain during a procedure makes tracking the spatial position and pose of the access port a difficult and challenging problem that has not yet been addressed prior to the present disclosure. Thus, there is a need to consider the use of an intelligent positioning system to assist in access port-based intracranial medical procedures and surgical navigation.
SUMMARY
A computer implemented method of adaptively and interoperatively configuring an automated arm used during a medical procedure, the method comprising:
    • identifying a position and an orientation for a target in a predetermined coordinate frame;
    • obtaining a position and an orientation for an end effector on the automated arm, the position and orientation being defined in the predetermined coordinate frame;
    • obtaining a desired standoff distance and a desired orientation between the target and the end effector;
    • determining a new desired position and a new desired orientation for the end effector from the position and orientation of the target and the desired standoff distance and the desired orientation; and
    • moving the end effector to the new position and orientation.
The end effector may be an imaging device having a longitudinal axis. The target may be a surgical port having a longitudinal axis. The desired orientation may be such that the longitudinal axis of the imaging device may be colinear with the longitudinal axis of the surgical port.
The imaging device may be an external video scope.
The desired standoff distance may be between 10 cm and 80 cm.
Alternatively, the desired standoff distance may be obtained from a predetermined list. The predetermined list may be related to specific users. The standoff distance may be either increased or decreased responsive to a user command. The user command may be received from one of a foot pedal, a voice command and a gesture.
The method may include a user moving the end effector to a position and defining a distance between the end effector and the target as the desired standoff distance.
The target may be moved during the medical procedure and the method may include identifying an updated position and orientation of the target, determining an updated new position and orientation for the end effector and moving the end effector to the updated new position and orientation.
The updated position and orientation of the target may be obtained continuously and the updated new position and orientation may be determined continuously.
The end effector may be moved to the updated new position and orientation responsive to a signal from a user. The signal from the user may be received from a foot pedal. The signal from the user may be one of a voice command and a gesture.
The end effector may be moved to the new desired position and orientation responsive to predetermined parameters. The predetermined parameters may be that the target has not moved for more than a particular period of time. The particular period of time may be 15 to 25 seconds. The particular period of time may be defined by a user. The predetermined parameters may be that the orientation may be off co-axial by greater than a predetermined number of degrees. The predetermined number of degrees may be defined by a user. The target may be a port and the predetermined parameters may be less than predetermined percentage of the total field of view of the port. The predetermined percentage may be defined by a user.
An intelligent positioning system for adaptively and interoperatively positioning and end effector in relation to a target during a medical procedure including: a automated arm assembly including a multi-joint arm having a distal end connectable to the end effector; a detection system for detecting a position of the target; a control system and associated user interface operably connected to the automated arm assembly and operably connected to the detection system, the control system configured for: identifying a position and an orientation for a target in a predetermined coordinate frame; obtaining a position and an orientation for an end effector on the automated arm assembly, the position and orientation being defined in the predetermined coordinate frame; obtaining a desired standoff distance and a desired orientation between the target and the end effector; determining a new position and a new orientation for the end effector from the position and orientation of the target and the desired standoff distance and the desired orientation; and moving the end effector to the new position and orientation.
The system may include a visual display and images from the imaging device may be displayed on the visual display.
An automated arm assembly for use with an end effector, a target, a detection system and may be for use during a medical procedure, the automated arm assembly includes: a base frame; a multi-joint arm operably connected to the base frame and having a distal end that may be detachably connectable to the end effector; a weight operably connected to the base frame that provides a counterweight to the multi-joint arm; and a control system operably connected to the multi-joint arm and to the detection system which provide information relating to a position of the target and the control system determines a new position and orientation for the distal end of the multi-joint arm in relation to the position of the target; and whereby the distal end of the multi-joint arm may be moved responsive to information from the control system.
The automated arm assembly may include a tower attached to the base frame and extending upwardly therefrom, the multi-joint arm may be attached to the tower and extends outwardly therefrom. The arm may be movably upwardly and downwardly on the tower. The automated arm assembly may include a supporting beam with one end movably attached to the tower and the other end to the automated arm. The multi-joint arm may have at least six degrees of freedom. The automated arm assembly may be moved manually. The base frame may include wheels.
The end effector may be tracked using the detection system. The multi-joint arm may include tracking markers which are tracked using the detection system. The automated arm assembly may include a radial arrangement attached to the distal end of the multi-joint arm and the end effector may be movable attached to the radial arrangement whereby the end effector moves along the radial arrangement responsive to information from the control system.
The automated arm assembly may include a joy stick operably connected to the control system and movement of the multi-joint arm may be controllable by the joy stick.
The end effector may be one of an external video scope, an abrasion laser, a gripper, an insertable probe or a micromanipulator. The end effector may be a first end effector and further including a second end effector attachable proximate to the distal end of the multi-joint arm. The second end effector may be wide angle camera.
The control system may constrain the movement of the multi-joint arm based on defined parameters. The defined parameters may include space above patient, floor space, maintaining surgeon line of sight, maintaining tracking camera line of sight, mechanical arm singularity, self-collision avoidance, patient collision avoidance, base orientation, and a combination thereof.
The automated arm assembly may include a protective dome attached to the multi-joint arm and the distal end of the multi-joint arm may be constrained to move only within the protective dome. A virtual safety zone may be defined by the control system and the distal end of the multi-joint arm may be constrained to move only within the safety zone.
An alignment tool for use with a surgical port including: a tip for insertion into the surgical port; and a generally conical portion at the distal end of the tip and attached such that the conical portion may be spaced outwardly from the end of port when the tip may be fully inserted into the portion. The conical portion may be made of a plurality of circular annotation.
In some embodiments, intelligent positioning systems (and associated methods) for supporting access port-based procedures are disclosed that include the following components: one or more imaging devices; a tracked and guided external automated arm configured to support one or more of the imaging devices; one or more tracking devices or mechanisms; one or more tracked markers or tracked marker assembly's; a navigation system configured to accept preoperative and/or intraoperative data; and an intelligent positioning system to control the pose and position of the automated arm.
In some embodiments, a software system is provided that includes a user interface for performing surgical procedures, where the user interface includes visualization and processing of images based on tracked devices, and intracranial images (optionally preoperative and intraoperative). The combined result is an efficient imaging and surgical interventional system that maintains the surgeon in a preferred state (e.g. one line of sight, bi-manual manipulation) that is suitable or tailored for performing surgery more effectively.
In some embodiments, as described below, the access port may be employed to provide for an optical visualization path for an imaging device. The imaging device acquires a high resolution image of the surgical area of interest and provides a means for the surgeon to visualize this surgical area of interest using a monitor that displays said image. The image may be still images or video stream.
In some embodiments, a system is provided that includes an intelligent positioning system, that is interfaced with the navigation system for positioning and aligning one or more imaging devices relative to (and/or within) an access port. In order to achieve automated alignment, tracking devices may be employed to provide spatial positioning and pose information in common coordinate frame on the access port, the imaging device, the automated arm, and optionally other surgically relevant elements such as surgical instruments within the surgical suite. The intelligent positioning system may provide a mechanically robust mounting position configuration for a port-based imaging sensor, and may enable the integration of pre-operative images in a manner that is useful to the surgeon. A further understanding of the functional and advantageous aspects of the disclosure can be realized by reference to the following detailed description and drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
Embodiments will now be described, by way of example only, with reference to the drawings, in which:
FIG. 1 is an exemplary embodiment illustrating system components of an exemplary surgical system used in port based surgery
FIG. 2 is an exemplary embodiment illustrating various detailed aspects of a port based surgery as seen in FIG. 1.
FIG. 3 is an exemplary embodiment illustrating system components of an exemplary navigation system.
FIG. 4A-E are exemplary embodiment of various components in an intelligent positioning system 4B
FIG. 5A-B are exemplary embodiments of an intelligent positioning system including a lifting column.
FIG. 6A-C are exemplary embodiments illustrating alignment of an imaging sensor with a target (port).
FIG. 7 is an exemplary embodiment of an alignment sequence implemented by the intelligent positioning system.
FIG. 8A is a flow chart describing the sequence involved in aligning an automated arm with a target.
FIG. 8B is a flow chart describing the sequence involved in aligning an automated arm with a target.
FIG. 9A is a flow chart describing the sequence involved in aligning an automated arm with a target.
FIG. 9B an illustration depicting a visual cue system for assisting a user in manually aligning an automated arm.
FIG. 10A-B is an illustration depicting tool characteristics that can be utilized in optical detection methods.
FIG. 11 is a flow chart describing the sequence involved in an embodiment for determining the zero position and desired position of the end effector;
FIG. 12A-B are exemplary embodiments illustration alignment of an access port in multiple views.
FIG. 13 an illustration depicting port characteristics that can be utilized in optical detection methods.
FIG. 14A-B are block diagrams showing an exemplary navigation system including an intelligent positioning system.
FIG. 15 is a flow chart describing the steps of a port based surgical procedure.
FIG. 16A-D are exemplary embodiments illustrating a port with introducer during cannulation into the brain.
DETAILED DESCRIPTION
Various embodiments and aspects of the disclosure will be described with reference to details discussed below. The following description and drawings are illustrative of the disclosure and are not to be construed as limiting the disclosure. Numerous specific details are described to provide a thorough understanding of various embodiments of the present disclosure. However, in certain instances, well-known or conventional details are not described in order to provide a concise discussion of embodiments of the present disclosure.
As used herein, the terms, “comprises” and “comprising” are to be construed as being inclusive and open ended, and not exclusive. Specifically, when used in the specification and claims, the terms, “comprises” and “comprising” and variations thereof mean the specified features, steps or components are included. These terms are not to be interpreted to exclude the presence of other features, steps or components.
As used herein, the term “exemplary” means “serving as an example, instance, or illustration,” and should not be construed as preferred or advantageous over other configurations disclosed herein.
As used herein, the terms “about” and “approximately” are meant to cover variations that may exist in the upper and lower limits of the ranges of values, such as variations in properties, parameters, and dimensions. In one non-limiting example, the terms “about” and “approximately” mean plus or minus 10 percent or less.
As used herein the term “Navigation system”, refers to a surgical operating platform which includes within it an Intelligent Positioning System as described within this document.
As used herein the term “Imaging sensor”, refers to an imaging system which may or may not include within it an Illumination source for acquiring the images.
As used herein, the term “tracking system”, refers to a registration apparatus including an operating platform which may be included as part of or independent of the intelligent positioning system which.
Several embodiments of the present disclosure seek to address the aforementioned inadequacies of existing devices and methods to support access port-based surgical procedures.
Minimally invasive brain surgery using access ports is a recently conceived method of performing surgery on brain tumors previously considered inoperable. One object of the present invention is to provide a system and method to assist in minimally invasive port-based brain surgery. To address intracranial surgical concerns, specific products such as the NICO BrainPath™ port have been developed for port-based surgery. As seen in FIG. 16A, port 100 comprises of a cylindrical assembly formed of an outer sheath. Port 100 may accommodate introducer 1600 which is an internal cylinder that slidably engages the internal surface of port 100. Introducer 1600 may have a distal end in the form of a conical atraumatic tip to allow for insertion into the sulci folds 1630 of the brain. Port 100 has a sufficient diameter to enable manual manipulation of traditional surgical instruments such as suctioning devices, scissors, scalpels, and cutting devices as examples. FIG. 16B shows an exemplary embodiment where surgical instrument 1612 is inserted down port 100.
FIG. 1 is a diagram illustrating components of an exemplary surgical system used in port based surgery. FIG. 1 illustrates a navigation system 200 having an equipment tower 101, tracking system 113, display 111, an intelligent positioning system 250 and tracking markers 206 used to tracked instruments or an access port 100. Tracking system 113 may also be considered an optical tracking device or tracking camera.
In FIG. 1, a surgeon 201 is performing a tumor resection through a port 100, using an imaging device 104 to view down the port at a suffcient magnification to enable enhanced visibility of the instruments and tissue. The imaging device 104 may be an external scope, videoscope, wide field camera, or an alternate image capturing device. The imaging sensor view is depicted on the visual display 111 which surgeon 201 uses for navigating the port's distal end through the anatomical region of interest.
An intelligent positioning system 250 comprising an automated arm 102, a lifting column 115 and an end effector 104, is placed in proximity to patient 202. Lifting column 115 is connected to a frame of intelligent positioning system 250. As seen in FIG. 1, the proximal end of automated mechanical arm 102 (further known as automated arm herein) is connected to lifting column 115. In other embodiments, automated arm 102 may be connected to a horizontal beam 511 as seen in FIG. 5A, which is then either connected to lifting column 115 or the frame of the intelligent positioning system 250 directly. Automated arm 102 may have multiple joints to enable 5, 6 or 7 degrees of freedom.
End effector 104 is attached to the distal end of automated arm 102. End effector 104 may accommodate a plurality of instruments or tools that may assist surgeon 201 in his procedure. End effector 104 is shown as an external scope, however it should be noted that this is merely an example embodiment and alternate devices may be used as the end effector 104 such as a wide field camera 256 (shown in FIG. 2), microscope and OCT (Optical Coherence Tomography) or other imaging instruments. In an alternate embodiment multiple end effectors may be attached to the distal end of automated arm 102, and thus assist the surgeon in switching between multiple modalities. For example, the surgeon may want the ability to move between microscope, and OCT with stand-off optics. In a further example, the ability to attach a second more accurate, but smaller range end effector such as a laser based ablation system with micro-control may be contemplated.
The intelligent positioning system 250 receives as input the spatial position and pose data of the automated arm 102 and target (for example the port 100) as determined by tracking system 113 by detection of the tracking markers 246 on the wide field camera 256 on port 100 as shown in FIG. 2. Further, it should be noted that the tracking markers 246 may be used to track both the automated arm 102 as well as the end effector 104 either collectively (together) or independently. It should be noted that the wide field camera 256 is shown in this image and that it is connected to the external scope 266 and the two imaging devices together form the end effector 104. It should additionally be noted that although these are depicted together for illustration of the diagram that either could be utilized independent of the other, for example as shown in FIG. 5A where an external video scope 521 is depicted independent of the wide field camera.
Intelligent positioninng system 250 computes the desired joint positions for automated arm 102 so as to maneuver the end effector 104 mounted on the automated arm's distal end to a predetermined spatial position and pose relative to the port 100. This redetermined relative spatial position and pose is termed the “Zero Position” and is described in further detail below and is shown in FIG. 6A-B where the imaging sensor and port are axially alligned 675 having a linear line of sight.
Further, the intelligent positioning system 250, optical tracking device 113, automated arm 102, and tracking markers 246 and 206 form a feedback loop. This feedback loop works to keep the distal end of the port (located inside the brain) in constant view and focus of the end effector 104 given that it is an imaging device as the port position may be dynamically manipulated by the surgeon during the procedure. Intelligent positioning system 250 may also include foot pedal 155 for use by the surgeon 201 to align of the end effector 104 (i.e., a videoscope) of automated arm 102 with the port 100. Foot pedal 155 is also found in FIGS. 5A, 5C and 7.
FIG. 3 is a diagram illustrating system components of an exemplary navigation system for port-based surgery. In FIG. 3, the main components to support minimally invasive access port-based surgery are presented as separated units. FIG. 1 shows an example system including a monitor 111 for displaying a video image, an optical equipment tower 101, which provides an illumination source, camera electronics and video storage equipment, an automated arm 102, which supports an imaging sensor 104. A patient's brain is held in place by a head holder 117, and inserted into the head is an access port 100 and introducer 1600 as shown in FIG. 16A. The introducer 1600 may be replaced by a tracking probe (with attached tracking marker 116) or a relevant medical instrument such as 1612 used for port-based surgery. The introducer 1600 is tracked using a tracking system 113, which provides position and orientation information for tracked devices to the intelligent positioning system 250.
An example of the surgeon dynamically manipulating the port 100 is shown in FIG. 16D. In FIG. 16C-D, a port based tumor resection is being performed within the brain 1640. The surgeon 201 will typically maneuver the port 100 to actively search for and provide access to as much of the tumor 120 or equivalently unhealthy tissue as possible in order to resect it using a medical instrument 1612. In FIG. 16C there is a section of the tumor 1680 that is not accessible given the positioning of the port 100. In order to access that section of the tumor 1680, the surgeon 201 maneuvers the port 100 through a rotation as shown by the dashed arrow 1665. Now referring to FIG. 16D this maneuvering of the port 100 allows the surgeon 201 to access the previously unaccessible section 1680 of the tumor 120 in order to resect it using the medical instrument 1612.
Arm Description
The method according to the invention described herein is suitable both for an individual automated arm of a multi-arm automated system and for the aforementioned single automated arm system. The gain in valuable operating time, shorter anesthesia time and simpler operation of the device are the direct consequences of the system according to an examplery version of the invention as shown in FIG. 1.
FIGS. 4B and 4C illustrate alternate example embodiments of automated arms. In FIG. 4B the distal end 408 is positioned using an extended automated arm 102 that extends over the surgeon 201. The base 428 of this arm 102 may be positioned away from the patient 202 to provide clear access to the patient 202 lying on the surgical bed. The base 428 may be equipped with caster wheel 458 to facilitate mobility within the operating room. A counter weight 438 may be provided to mechanically balance the system and minimize the load on the actuators (this weight serving the same function as weight 532 in FIG. 5B). The distal end 408 can be arbitrarily positioned due to the presence of a redundant number of degrees of freedom. Joints, such as rotating base 418 in FIG. 4B and joint 448 provide these degrees of freedom. The imaging device 104 may be attached to the final joint or equivalently the distal end 408.
FIG. 4C illustrates another embodiment where a commercially available arm 102 may be used. Again, joints 448 provide redundant number of degrees of freedom to aid in easy movement of the distal end 408. In another embodiment, the distal end may have connectors that can rigidly hold an imaging device while facilitating easy removal of the device to interchange with other imaging devices.
FIG. 4D illustrates an alternative embodiment in which a radial arrangement 499 is employed for the distal end. This arrangement allows the end effector to slide along the curved segment 499 to provide a unique degree of freedom.
It should be noted that while FIGS. 4B-C illustrate a floor-standing design, this embodiment is not intended to limit the scope of the disclosure, and it is to be appreciated that other configurations may be employed. For example, alternative example configurations include a structure that is supported from the ceiling of the operating room; a structure extending from a tower intended to encase imaging instrumentation; and by rigidly attaching the base of the automated arm to the surgical table.
In some embodiments, multiple arms may be used simultaneously for one procedure and navigated from a single system. In such an embodiment, each distal end may be separately tracked so that the orientation and location of the devices is known to the intelligent positioning system and the position and/or orientation of the mounted distal end devices may be controlled by actuating the individual automated arms based on feedback from the tracking system. This tracking can be performed using any of the methods and devices previously disclosed.
In an alternate embodiment, the head of the patient may be held in a compliant manner by a second automated arm instead of a rigid frame 117 illustrated in FIG. 1. The automated head support arm can be equipped with force sensing actuators that provide signals that enable the tracking of minor movement of the head. These sensed position of the head may be provided as feedback to control the relative position of the first automated arm, and correspondingly position the distal end used to mount the device (such as an imaging sensor). This coupling of the head holding assembly and the imaging system may aid in reducing movement artefacts while providing patient comfort. Patient comfort will be greatly enhanced due to the elimination of sharp points used in the traditional head immobilization systems.
In current surgical procedures, available operating room space around the patient being operated on is a scarce commodity due to the many personnel and devices needed to perform the surgery. Therefore the space required by the device around the surgical bed being minimized is optimal.
In an embodiment the space required by the automated arm may be minimized comparatively to presently used surgical arms through the use of a cantilevered design. This design element allows the arm to be suspended over the patient freeing up space around the patient where most automated arms presently occupy during the surgical procedures. FIG. 5(a) shows such a cantilevered arm 511, where the arm anchor is a weighted base 512. This allows the arm to be suspended with minimized risk of tipping, as the weighted base offsets the arm.
In another embodiment the space required by the automated arm may be minimized comparatively to presently used surgical arms through the use of a concentrated counterweight 532 attached to the base of the automated arm 512, which takes up a small footprint not only in its height dimension but as well as the floor area in which it occupies. It should be noted that the reduction in area used in the height direction is space that can be occupied by other devices or instruments in the OR such as a surgical tool table. In addition the smaller area required by the base of this automated arm can allow for less restricted movement of personnel around the patient as well as more supplementary device and instruments to be used. FIG. 5B shows such a base which utilizes minimum space and has a concentrated weight 532. The automated arm in this example is held at a particular height by a lifting column 115, as this design requires minimal space. In addition some alternate embodiments that could be used for the lifting column 115 include a 4-bar arm, a scissor lift and pneumatic pistons
Tracking
In an embodiment as illustrated in FIG. 2 and FIG. 4E, tracking markers 206 may be fitted to port 100. The spatial position and pose of the port (target) are determined using the tracking markers 206 and are then detected by the tracking device 113 shown in FIG. 1 and registrered within a common coordinate frame. From the spatial position and pose of the port 100 (target), the desired position of the end effector 104 and the automated arm 102 may be determined. As shown as FIG. 7, lifting column 115 may raise or lower automated arm 102 from an actual position 700 to a desired position 710. For this purpose, it is possible, for example, for the tracking markers 246 located on an assembly as shown in FIG. 2 to be fitted on the automated arm 102, so that its spatial position and pose in the operating room (OR) can thus be determined by the tracking device 113 and the intelligent positioning system 250. Further, the automated arms spatial position and pose can also be determined using position encoders located in the arm that enable encoding of joint angles. These angles combined with the lengths of the respective arm segments can be used to infer the spatial position and pose of the end effector 104 or equivalently the imaging sensor (for example the exoscope 521 shown in FIG. 5A) relative to base 512 of intelligent positioning system 250. Given the automated arms base's 512 spatial position and pose is registered to the common coordinate frame.
In an embodiment, passive tracking markers such as the reflective spherical markers 206 shown in FIG. 2 are seen by the tracking device 113 to give identifiable points for spatially locating and determining the pose of a tracked object (for example a port 100 or external scope 521) to which the tracking markers are connected to.
As seen in FIG. 4E, a medical instrument (target) such as port 100 may be tracked by a unique, attached marker assembly 465 which is used to identify the corresponding medical instrument inclusive of its spatial position and pose as well as its 3D volume representation to a navigation system 200, within the common coordinate frame. In FIG. 4E Port 100 is rigidly connected to tracking marker assembly 465 which is used to determine its spatial position and pose in 3D. Typically, a minimum of 3 spheres are placed on a tracked medical instrument or object to define it. In the exemplary embodiment of FIG. 4E, 4 spheres are used to track the target object (port).
The navigation system typically utilizes a tracking system. Locating tracking markers is based, for example, on at least three tracking markers 206 that are arranged statically on the target (for example port 100) as shown in FIG. 2 on the outside of the patient's body 202 or connected thereto. A tracking device 113 as shown in FIG. 1 detects the tracking markers 206 and determines their spatial position and pose in the operating room which is then registered to the common coordinate frame and subsequently stored by the navigation system.
An advantageous feature of an optical tracking device is the selection of markers that can be segmented very easily and therefore detected by the tracking device. For example, infrared (IR)-reflecting markers and an IR light source can be used. Such an apparatus is known, for example, from tracking devices such as the “Polaris” system available from Northern Digital Inc. In a further embodiment, the spatial position of the port (target) 100 and the position of the automated arm 102 are determined by optical detection using the tracking device. Once the optical detection occurs the spatial markers are rendered optically visible by the device and their spatial position and pose is transmitted to the intelligent positioning system and to other components of the navigation system.
In a preferred embodiment, the navigation system or equivalently the intelligent positioning system may utilize reflectosphere markers 206 as shown in FIG. 4E in combination with a tracking device, to determine spatial positioning of the medical instruments within the operating theater. Differentiation of the types of tools and targets and their corresponding virtual geometrically accurate volumes could be determined by the unique individual specific orientation of the reflectospheres relative to one another on a marker assembly 445. This would give each virtual object an individual identity within the navigation system. These individual identifiers would relay information to the navigation system as to the size and virtual shape of the instruments within the system relative to the location of their respective marker assemblies. The identifier could also provide information such as the tools central point, the tools central axis, etc. The virtual medical instrument may also be determinable from a database of medical instruments provided to the navigation system.
Other types of tracking markers that could be used would be RF, EM, LED (pulsed and un-pulsed), glass spheres, reflective stickers, unique structures and patterns, where the RF and EM would have specific signatures for the specific tools they would be attached to. The reflective stickers, structures and patterns, glass spheres, and LEDs could all be detected using optical detectors, while RF and EM could be picked up using antennas. Advantages to using EM and RF tags would include removal of the line of sight condition during the operation, where using optical system removes the additional noise from electrical emission and detection systems.
In a further embodiment, printed or 3-D design markers could be used for detection by the imaging sensor provided it has a field of view inclusive of the tracked medical instruments. The printed markers could also be used as a calibration pattern to provide (3-D) distance information to the imaging sensor. These identification markers may include designs such as concentric circles with different ring spacing, and/or different types of bar codes. Furthermore, in addition to using markers, the contours of known objects (i.e., side of the port) could be made recognizable by the optical imaging devices through the tracking system as described in the paper [Lepetit, Vincent, and Pascal Fua. Monocular model-based 3D tracking of rigid objects. Now Publishers Inc, 2005]. In an additional embodiment, reflective spheres, or other suitable active or passive tracking markers, may be oriented in multiple planes to expand the range of orientations that would be visible to the camera.
In an embodiment illustrating a port used in neurosurgery, as described above is shown by way of example in FIG. 16B, which shows an access port 100 that has been inserted into the brain, using an introducer 1600, as previously described. In the illustration shown in FIG. 16B, the introducer has been removed. The same access port 100 shown in FIG. 4E includes a plurality of tracking elements 206 as part of a tracking marker assembly 465. The tracking marker assembly is comprised of a rigid structure 445 to supports the attachment of a plurality of tracking elements 206. The tracking markers 206 may be of any suitable form to enable tracking as listed above. In some embodiments, assembly 465 may be attached to access port 100, or integrated as part of access port 100. It is to be understood that the orientation of the tracking markers may be selected to provide suitable tracking over a wide range of relative medical instrument positional orientations and poses, and relative imaging sensor positional orientations and poses.
Safety System
A challenge with automated movement in a potentially crowded space, such as the operating room, may be the accidental collision of any part of the automated arm with surgical team members or the patient. In some embodiments, this may be avoided by partially enclosing the distal end 408 within a transparent or translucent protective dome 645 as shown in FIG. 6A that is intended to prevent accidental contact of the end effector 104 or equivalently the imaging sensor 521 with surgical team members or the patient.
In an alternate embodiment the protective dome may be realized in a virtual manner using proximity sensors. Hence, a physical dome may be absent but a safety zone 655 around the distal end 408 as shown in FIGS. 6B and 6C may be established. In an embodiment this can be accomplished by using proximity sensor technologies to prevent accidental contact between surgical team members and any moving part of the automated arm with mounted imaging sensor. A further embodiment may include a collision sensor to ensure that the moving automated arm does not collide with any object in the environment. This may be implemented using electrical current sensors, force or velocity sensors and/or defined spatial limits of the automated arm.
It should be noted that the safety systems described above are exemplary embodiments of various safety systems that can be utilized in accordance with the intelligent positioning system and should not be interpreted as limiting the scope of this disclosure. In an embodiment the intelligent positioning system is able to acquire the spatial position and pose of the target as well as the automated arm as described above. Having this information the intelligent positioning system can be imposed with a constraint to not position the automated arm within a safety semicircle around the target. In an additional embodiment depicted in FIG. 6C a reference marker 611 can be attached to the patient immobilization frame (117) to provide a reference of the spatial position and pose of the head of the patient, in the common coordinate frame, to the intelligent positioning system through tracking mechanisms described above.
Once the position of this reference marker is determined a positional constraint can be imposed on the automated arm effectively defining a “no-fly zone”. Given the reference marker 611 has coordinates
(xr, yr, zr, αr, βr, γr)
Where the subscript “r” denotes a coordinate of the reference marker and α, β, γ, are the degree of roll, pitch, and yaw of the marker. Then a new reference origin within the common coordinate frame can be defined by assigning the spatial position of the marker to be the origin and the top, left and right sides of the marker (as determined relative to the common coordinate frame by inferring from the acquired roll, pitch, and yaw) to be the z direction, x direction, and y directions relative to the new reference origin within the common coordinate frame. Given that the position of the end effector on the automated arm is defined in spherical coordinates for example
(rE, φE, θE)
Where the subscript “E” denotes a coordinate of the end effector, a region can be defined in spherical coordinates which can constrain the movement of the end effector to an area 655 outside of which will be defined a “no-fly zone”. This can be achieved by defining an angular range and radial range relative to the reference origin which the end effector cannot cross. An example of such a range is shown as follows:
rmin<rE<rmax
φminEmax
θminEmax
Where the subscripts “min” denotes the minimum coordinate in a particular spherical direction the end effector can occupy and the subscript denotes the maximum coordinate in a particular spherical direction the end effector can occupy. Exemplary radial and angular limit ranges are given for two dimensions as follows and are shown in FIG. 6C as 651 (rmin) to 621 (rmax) and 631min) to 641max) respectively. This embodiment may also be used to define additional constrained regions for example such as those concerned with conserving line of sight of the surgeon, conserving line of sight of the tracking device with the tracking markers on the end effector, and conserving the area in which the surgeon hands will be utilizing the tools. Referring to the port based surgery described above a common acceptable offset range (for example the dotted line 661 defining the length from the reference marker to the beginning of the “fly-zone” shown in FIG. 6C) of the end effector to the target, to allow the surgeon to work comfortably is 20 cm to 40 cm (i.e. in this rmin=20 cm and rmax=40 cm).
In another embodiment, a safety zone may be established around the surgical team and patient using uniquely identifiable tracking markers that are applied to the surgical team and patient. The tracking markers can be limited to the torso or be dispersed over the body of the surgical team but sufficient in number so that an estimate of the entire body of each individual can be reconstructed using these tracking markers. The accuracy of modelling the torso of the surgical team members and the patient can be further improved through the use of tracking markers that are uniquely coded for each individual and through the use of profile information that is known for each individual similar to the way the tracking assemblies identify their corresponding medical instruments to the intelligent positioning system as described above. Such markers will indicate a “no-fly-zone” that shall not be encroached when the end effector 104 is being aligned to the access port by the intelligent positioning system. The safety zone may be also realized by defining such zones prior to initiating the surgical process using a pointing device and capturing its positions using the navigation system.
In another embodiment multiple cameras can be used to visualize the OR in 3D and track the entire automated arm(s) in order to optimize their movement and prevent them from colliding with objects in the OR. Such a system capable of this is described by the paper [System Concept for Collision-Free Robot Assisted Surgery Using Real-Time Sensing”. Jörg Raczkowsky, Philip Nicolai, Björn Hein, and Heinz Wörn. IAS 2, volume 194 of Advances in Intelligent Systems and Computing, page 165-173. Springer, (2012)]
Additional constraints on the intelligent positioning system used in a surgical procedure include self-collision avoidance and singularity prevention of the automated arm which will be explained further as follows. The self-collision avoidance can be implemented given the kinematics and sizes of the arm and payload are known to the intelligent positioning system. Therefore it can monitor the joint level encoders to determine if the arm is about to collide with itself. If a collision is imminent, then intelligent positioning system implements a movement restriction on the automated arm and all non-inertial motion is ceased.
In an exemplary embodiment given an automated arm with 6 degrees of freedom, the arm is unable to overcome a singularity. As such when a singularity condition is approached the intelligent positioning system implements a movement restriction on the automated arm and all non-inertial motion is ceased. In another exemplary embodiment such as that shown in FIG. 5A an automated arm with six degrees of freedom is provided another degree of freedom by the addition of a lifting column 115. In this case singularities can be overcome as the restricted motion in one joint can be overcome with the movement of another joint. Although this allows the intelligent positioning system to overcome singularities it is a more difficult kinematics problem. An end-effector pose is defined by 3 translational and 3 rotational degrees of freedom; to do the inverse kinematics of a 7DOF manipulator requires that you invert a 6×7 matrix, which is not unique. Therefore, while a 7 degree of freedom manipulator allows you to get around singularities due to this non-uniqueness, it is at an additional computational cost. By adding an extra constraint, like the elbow constrained to stay at a particular height, the system would allow a unique solution to be found which would again ease the computational requirement of the system.
Having the automated arm be mobile for medical flexibility and economic viability, instills another constraint on the intelligent positioning system. This is to ensure either the mobile base 512 is in motion or the automated arm is in motion at any given time. This is accomplished by the system by having an auto-locking mechanism which applies breaks to the base when movement of the arm is required. The reasoning for this constraint is movement of the arm without a static base will result in synonymous motion of the base (basic physics). If the arm is mounted on a vertical lifting column, the lifting column adds to this constraint set: the lifting column cannot be activated if the mobile base wheels are not braked or if the arm is in motion. Similarly, the arm cannot be moved if the lifting column is active. If the mobile base wheel brakes are released, the arm and lifting column are both disabled and placed in a braked state.
Advantages of Arm
In an advantageous embodiment of the system, the automated arm with mounted external scope will automatically move into the zero position (i.e. the predetermined spatial position and pose) relative to the port (target) by the process shown in FIG. 8A. When this is done during the surgical procedure it is possible to start immediately on the treatment of the patient allowing the surgeon to skip the periodic manual step of realigning the external scope with the port.
In the preferred embodiment the chosen position of the automated arm will align the distal end with mounted external scope, to provide the view of the bottom (distal end) of the port (for port based surgery as described above). The distal end of the port is where the surgical instruments will be operating and thus where the surgical region of interest is located. In another embodiment this alignment (to provide the view at the bottom of the port) can be either manually set by the surgeon or automatically set by the system depending on the surgeons' preference and is termed the “zero position”. To automatically set the view, the intelligent positioning system will have a predefined alignment for the end effector relative to the port which it will use to align automated arm.
Referring to FIG. 6A which depicts the preferred zero position of the end effector 104 with respect to the port 100. The relative pose of the imaging device (either the external scope 521 or wide field camera 256) is selected such that it guarantees both a coaxial alignment and an offset 675 from the proximal end of the port as shown in both FIGS. 6A-B. More specifically, there ensues a co-axial alignment of the imaging device axis forming, for example, a central longitudinal axis of the imaging device with the longitudinal axis of the port (target) (such as 675 shown in FIGS. 6A-B) as predefined by the zero position. This is particularly suitable for cases such as the port based surgery method mentioned above for tumor resection, as well as Lumbar Microscopic Discectomy and Decompression as it allows the port to be viewed from the optimal angle resulting in the largest field of view for the surgeon, where the surgeon will be manipulating their surgical instruments to perform the surgery. For example, as is described above and illustrated in FIGS. 16A, 16B, and 16C. A co-linear alignment would provide the optimal view given the imaging devices' line of sight is normal to the plane of the region of interest, preventing occlusion by the ports walls which would occur in alternate lines of sight.
Manual/Semi-Manual Automated Arms
The example embodiment of the automated arms shown in FIGS. 6A and 6B and described in the prior paragraph, are shown supporting an external imaging device having tracking markers 246 attached thereto. In these figures, a floor mounted arm is shown with a large range manipulator component 685 that positions the end effector of the automated arm (for example, with 6 degrees of freedom), and has a smaller range of motion for the positioning system (for example, with 6 degrees of freedom) mounted on distal end 408. As shown in FIG. 6A, the distal end of the automated arm 408 refers to the mechanism provided at the distal portion of the automated arm, which can support one or more end effectors 104 (e.g. imaging sensor). The choice of end effector would be dependent on the surgery being performed.
Alignment of the end effector of the automated arm is demonstrated in FIGS. 6A-B. When the access port is moved, the system detects the motion and responsively repositions the fine position of the automated arm to be co-axial 675 with the access port 100, as shown in FIG. 6B. In a further embodiment, the automated arm may maneuver through an arch to define a view that depicts 3D imaging. There are 2 ways to do this—1) is to use two 2D detectors at known positions on the arm, or use one 2D detector and rock back and forth in the view (or move in and out).
Alignment
FIG. 7 is a representation of an alignment sequence implemented by the intelligent positioning system. In FIG. 7, the automated arm 102 may be moved from its actual position 700 into its desired position 710 with the aid of a cost minimization algorithm or equivalently an error minimization method by the intelligent positioning system 250.
In FIG. 7, the the actual position 700 of the automated arm 102 is acquired continually. The automated arm achieves the desired alignment (zero position) with the target (port 100) through movement actuated by the intelligent positioning system. The intelligent positioning system 250 requires the actual position 700 of the arm 102 to approximate the desired position of the arm 710 as depicted by arrow 720 in FIG. 7. This approximation occurs until the position of the actual arm alignment approximates that of the desired alignment (zero position) within a given tolerance. At the desired alignment 710, the automated arm 102 mounted with the imaging device 104 is then in the zero position with respect to the target (port 100). The subsequent alignment of the automated arm 102 into the desired position 710 relative to the port 100 may be actuated either continuously or on demand by the surgeon 201 through use of the foot pedal 155.
The cost minimization method applied by the intelligent positioning system is described as follows and depicted in FIG. 8A. In an embodiment visual serving is executed in a manner in which tracking device(s) 113 are used to provide an outer control loop for accurate spatial positioning and pose orientating of the distal end of the automated arm 102. Where imaging device 104 may be attached. The Intelligent positioning system also utilizes this open control loop to compensate for deficiencies and unknowns in the underlying automated control systems, such as encoder inaccuracy.
FIG. 8A is an exemplary flow chart describing the sequence involved in aligning an automated arm with a target using a cost minimization method. In the first step (810) the end effectors spatial position and pose is determined, typically in the common coordinate frame, through the use of the tracking device or another method such as the template matching or SIFT techniques described in more detail below. In the next step (820), the desired end effector spatial position and pose is determined with the process 1150 shown in FIG. 11 and described further below.
The pose error of the end effector as utilized in step (830), is calculated as the difference between the present end effector spatial position and pose and the desired end effector spatial position and pose and is shown as arrow distance 720 in FIG. 7. An error threshold as utilized in step (840) is determined from either the pose error requirements of the end effector or the automated arm limitations. Pose error may include resolution of the joints, minimizing power, or maximizing life expectancy of the motors. If the pose error of the end effector is below the threshold, then no automated arm movement is commanded and the intelligent positioning system waits for the next pose estimation cycle. If the pose error is greater than the threshold the flow chart continues to step (850) where the end effector error 720 is determined by the intelligent positioning system as a desired movement. The final step (860) requires the intelligent positioning system to calculate the required motion of each joint of the automated arm 102 and command these movements. The system then repeats the loop and continuously takes new pose estimations from the intelligent positioning system 250 to update the error estimation of the end effector spatial position and pose.
Alignment Flow Chart
In an embodiment the intelligent positioning system can perform the alignment of the automated arm relative to the port optimized for port based surgery using the method as described by the flow chart depicted in FIG. 8B. FIG. 8B describes the method implemented in the flow chart in FIG. 8A in a refined version as used in the port based surgery described above. In FIG. 8B, an exemplary system diagram is shown illustrating various component interactions for tracking of the access port (target) by the automated arm supporting an imaging device. Tracking and alignment may be triggered manually by the surgeon, or set to track continuously or various other types of automated arm alignment modes as described below in further detail. In both given example modes, the operational flow may be performed as follows:
    • 1. The tracking device(s) transmits the spatial positions and poses of the access port patient and end effector, analogous to step 810 in FIG. 8A, to the intelligent positioning system after which they are registered to the common coordinate frame. The coordinates in this step are given for the port, the patient, and the end effector as 815, 805, and 825 as shown in FIG. 8B respectively.
    • 2. If, for example, the imaging sensor is to be continuously (i.e. in real time) aligned relative to the access port at the zero position as described below (in the common coordinate frame), a new desired spatial position and pose for the end effector (mounted with the imaging sensor) including the zoom, and focus of the camera is calculated which is shown as step (845) in FIG. 8B and is analogous to 820 in FIG. 8A, as described above. In an embodiment the zero position is one that will orient the imaging device coaxially with the access port during a port based surgery as described in more detail below in the description of FIG. 15. If, alternatively, the end effector is continuously aligned relative to a medical instrument for example the surgical pointer tools 1015 and 1005 as shown in FIG. 10B, the same calculations are computed to orient the imaging sensor such that the focal point is aimed at the tip of the medical instrument or aligned relative to it in a predetermined (by the process described in FIG. 11) zero position.
    • 3. In the next step (855), analogous to step 850 in FIG. 8A, of the process the intelligent positioning system (using an inverse kinematics engine) reads the current joint positions of the automated arm and computes offset joint positions for the automated arm that would achieve the desired spatial position and pose of the end effector as defined by the zero position.
    • 4. The intelligent positioning system then drives the joints to the desired joint angles via a motor controller (865) contained in the intelligent positioning system, this step is analogous to step 860 in FIG. 8A. Inputs into the motor controller include the joint encoders (885) located in the automated arm as well as any connected (i.e. to the intelligent positioning system) force/torque sensors 875. It will be understood that various strategies can be used for the determination of the trajectory of the automated arm. Some examples are: straight line path of the distal end frame, equal joint speed, and equal joint travel time. If the location and geometry of other equipment in the vicinity of the arm are known.
    • 5. During the execution of the automated arm trajectory, one or more gauges, sensors or monitors (such as motor current, accelerometers and or force gauges) may be monitored to halt the arm in the case of collision. Other inputs to prevent a collision include proximity sensors that would give information (835) on the proximity of the automated arm relative to obstacles in the automated arms vicinity as well as defined “no-fly zones” 655 depicted in FIGS. 6B-C and described herein.
Because the surgical arena is filled with many pieces of equipment and people, it may be desirable that all gross-alignment of the distal end is performed manually and only the fine adjustment is performed automatically from tracked data.
Constant realignment of an end effector with a moving target during a port based surgery is problematic to achieve as the target is moved often and this can result in increased hazard for the equipment and personnel in the surgical suite. Movement artefacts can also induce motion sickness in the surgeons who constantly view the system. There are multiple embodiments that can deal with such a problem two of which will be described further. The first involves the intelligent positioning system constraining the arm movement so that it only realigns with the target if the target has been in a constant position, different from its initial position, for more than a particular period of time. This would reduce the amount of movement the arm undergoes throughout a surgical procedure as it would restrain the movement of the automated arm to significant and non-accidental movements of the target. Typical duration for maintaining constant position of the target in port based brain surgery is 15 to 25 seconds. This period may vary for other surgical procedures even though the methodology is applicable. Another embodiment may involve estimation of the extent of occlusion of the surgical space due to misalignment of the port relative to the line of sight of the video scope 104. This may be estimated using tracking information available about the orientation of the port and the orientation of the video scope. Alternatively, extent of occlusion of the surgical space may be estimated using extent of the distal end of the port that is still visible through the video scope. An example limit of acceptable occlusion would be 0-30%.
The second embodiment is the actuation mode described herein. Alternate problems with constant realignment of the end effector can be caused by the target as it may not be so steadily placed that it is free of inadvertent minuscule movements that the tracking system will detect. These miniscule movements may cause the automated arm to make small realignments synchronous with small movements of the port. These realignments can be significant as the end effector may be realigning in a radially manner to the port and hence a small movement of the target may be magnified at a stand-off distance (i.e. angular movements of the target at the location of the target may cause large absolute movements of the automated arm located at a radial distance away from the target). A simple way to solve this problem is to have the intelligent positioning system only actuate movement of the arm, if the automated arm's realignment would cause the automated arm to move greater than a threshold amount. For example a movement which was greater than five centimeters in any direction.
Template Matching and Sift Alignment Technique
An alternate method of aligning the port is to use machine vision applications to determine the spatial position and pose of the port from the imaging acquired by the imaging sensor. It should be noted that these techniques (i.e. template matching and SIFT described below) can be used as inputs to step (810) in the flow chart depicted in FIG. 8A and described in detail above, as opposed to the optical tracking devices described above.
The mentioned methods utilize a template matching technique or in an alternate embodiment a SIFT Matching Technique to determine the identity, spatial position, and pose of the target, relative to the end effector mounted on the automated arm. In one embodiment the template matching technique would function by detecting the template located on the target and inferring from its skewed, rotated, translated, and scaled representation in the captured image, its spatial position and pose relative to the imaging sensor.
FIGS. 10A and 10B are illustrations depicting target characteristics that can be utilized in optical detection methods. The FIGS. 10A and 10B contain two targets the first being a surgical pointer tool 1015 and the second being a port 100 both having attached templates 1025 and 1030 respectively. In an alternate detection method the SIFT technique functions by using a known size ratio of two or more recognizable features of a target to analyze an image obtained by an imaging sensor to detect the target. For example as shown in FIG. 10A, the features could be the inner 1020 and outer circumference 1010 contours of the lip of the port 100. Once the feature is identified the SIFT technique uses the features' skewed, rotated, translated, and scaled representation in the analyzed image to infer its spatial position and pose relative to the imaging sensor. Both the SIFT Matching and Template Matching Techniques are described in detail by the paper [Monocular Model-Based 3D Tracking of Rigid Objects: A Survey]. It should be noted that other 3D Tracking methods can be used to determine the identity, spatial position, and pose of a target relative to an imaging sensor through analyzing the imaging obtained by the imaging sensor such as described throughout the mentioned paper [Monocular Model-Based 3D Tracking of Rigid Objects: A Survey, section 4].
Manual/Semi Manual Flow
In further implementations of an intelligent positioning system, both manual and automatic alignment of the automated arm may be achieved using the same mechanism through use of force-sensing joints in the automated arm that would help identify intended direction of motion as indicated by the user (most likely the surgeon and surgical team). The force sensors embedded in the joints can sense the intended direction (e.g. pull or push by the user (i.e. surgical team or surgeon)) and then appropriately energize the actuators attached to the joints to assist in the movement. This will have the distal end moved using powered movement of the joints guided by manual indication of intended direction by the user.
In a further implementation, the spatial position and pose of the distal end or equivalently the mounted external device may be aligned in two stages. The two alignment stages of the present example implementation include 1) gross alignment that may be performed by the user; 2a) fine positioning that may be performed by the user and assisted by the intelligent positioning system; and/or 2b) fine positioning that is performed by the intelligent positioning system independently. The smaller range of motion described in steps 2a) and more apparently in 2b) is optionally bordered by a virtual ring or barrier, such that as the system operates to align the distal end, the distal end does not move at such a pace as to injure the surgeon, patient or anyone assisting the surgery. This is achieved by constraining the motion of the automated arm to within that small ring or barrier. The ring or barrier may represent the extent of the smaller range of motion of the automated arm controlled by the intelligent positioning system.
In further embodiments, the user may override this range and the system may re-center on a new location through step 1 as described above, if the larger range of motion of the automated arm controlled by the intelligent positioning system is also automated.
An example alignment procedure is illustrated in the flow chart shown in FIG. 9A within the example context of an external imaging device mounted to the automated arm. In this case, a user may initially set the gross alignment joints to a neutral position (900) and wheel it into close proximity of the patient (910). In this position, the intelligent positioning system computes a target end effector spatial position and pose coordinate based on the zero position (920) that will aim the imaging device coaxially (or in another zero position) relative to the access port 100, or, for example, at the tip of a surgical pointer tools 1005 and 1015 shown in FIG. 10B.
In FIG. 9A, the kinematics engine outputs a set of preferred automated arm joint readings to the user that will achieve the zero position within the tolerance achievable by gross alignment (922). The user may then employ these readings to manually perform the initial alignment step (925). In other embodiments, the user may choose to manually adjust the coarse positioning by visual feedback alone, or based on a combination of visual feedback and preferred joint readings. In yet another embodiment, the user may manually perform the initial alignment guided by feedback from the system. For example, the system may provide visual and/or audible information indicating to the user the proximity of the alignment of the system to a pre-selected target range or region of the alignment in the common coordinate frame. The feedback provided may assist the user in identifying a suitable gross alignment, for example, by directing the user's alignment efforts.
In another embodiment, the user may be able to grab the end effector and through a force/torque control loop, guide the end effector into a gross-alignment. This control methodology may also be applied should the surgeon wish to re-orient the external imaging device to be non-coaxial to the access port.
Once the gross alignment is complete, the intelligent positioning system may be employed to perform the fine alignment by moving the automated arm such that the imaging device is brought into the exact zero position via any of the algorithms described above and depicted in FIGS. 8A and 8B. The flow chart shown on the right side of FIG. 9A is another exemplary embodiment describing an automated alignment process which can be executed by the intelligent positioning system again analogous to the flow chart depicted in FIG. 8A.
According to the present embodiments, the alignment of the imaging device is semi-automated; the actions are performed with operator intervention, and feedback from the intelligent positioning system is performed to provide for the fine and/or final alignment of the external device.
During the operator assisted alignment, the spatial position and pose of the imaging device is tracked, for example, by any of the aforementioned tracking methods, such as through image analysis as described above, or by tracking the position of the access port and imaging sensor using reflective markers, also as described above.
The tracked spatial position and pose is employed to provide feedback to the operator during the semi-automated alignment process. A number of example embodiments for providing feedback are presented below. It is to be understood that these embodiments are merely example implementations of feedback methods and that other methods may be employed without departing from the scope of the present embodiment. Furthermore, these and other embodiments may be used in combination or independently.
In one example implementation, haptic feedback may be provided on the automated arm to help manual positioning of the external device for improved alignment. Where an example of haptic feedback is providing a tactile click on the automated arm to indicate the position of optimal alignment. In another example, haptic feedback can be provided via magnetic or motorized breaks that increase movement resistance when the automated arm is near the desired orientation.
In another embodiment, a small range of motion can be driven through, for example magnets or motors, which can drive the spatial position and pose of the external device into desired alignment when it is manually positioned to a point near the optimal position. This enables general manual positioning with automated fine adjustment.
Another example implementation of providing feedback includes providing an audible, tactile or visual signal that changes relative to the distance to optimal positioning of the access port. For example, two audible signals may be provided that are offset in time relative to the distance from optimal position. As the imaging sensor is moved towards optimal position the signals are perceived to converge. Right at the optimal position a significant perception of convergence is realized. Alternatively, the signal may be periodic in nature, where the frequency of the signal is dependent on the distance from the desired position. It is noted that human auditory acuity is incredibly sensitive and can be used to discriminate very fine changes. See for example: http://phys.org/news/2013-02-human-fourier-uncertainty-principle.html.
In another example implementation, visual indicators may be provided indicating the direction and amount of movement required to move the imaging sensor into alignment. For example, this can be implemented using light sources such as LEDs positioned on the automated arm, or, for example, a vector indicator on the video display screen of the camera. An example illustration of the vector indicator is shown in FIG. 9B where the arrows 911, 921 and 931 represent visual indicators to the user performing the manual movement. In this figure a shorter arrow 921 represents the spatial position and pose of the imaging device being closer to its required position compared to the longer arrow shown in 911.
Zero Positioning
In an embodiment steps may be taken to set the relative spatial position and pose of the automated arm (mounted with external device or equivalently an imaging device) with respect to the target in the common coordinate frame. for example, that of manually placing the imaging sensor in a chosen spatial position and pose relative to the target spatial position and pose and defining this position to the intelligent positioning system as a zero (chosen) position relative to the port. Which the imaging sensor and accordingly the automated arm should constantly return to, when prompted by the surgeon or automatically by the intelligent positioning system.
An exemplary embodiment to set the zero position and determine the desired spatial position and pose of the end effector relative to the target are shown in the flow charts in FIG. 11. The left flow chart 1100 describes how to set the zero position and is described further as follows. The first step 1110 is to position the end effector relative to the target in the desired spatial position and pose (manually). Once this is completed the intelligent positioning system moves to the next step 1120 where it acquires the spatial position and pose of the end effector in the common coordinate frame. In the same step it stores this spatial position and pose as coordinates in the common coordinate frame, for example, shown as follows;
(xe,ye,zeeee)
Where the subscript “e” denotes the coordinates of the end effector and the variables α, β, and γ represent roll, pitch, and yaw respectively. The next step 1130 is the same as the prior step 1120 only that the process is applied to the target. Example coordinates acquired for this step are shown as follows;
(xt,yt,ztttt)
Where the subscript “t” denotes the coordinates of the target. The final step 1140 in the flow chart is to subtract the target coordinates from the end effector coordinates to obtain the “Zero Position” coordinates. The “Zero Position” coordinates is a transform that when added to the dynamic target coordinates during surgery can reproduce the relative position of the end effector to the target in the zero position. An example of this calculation is shown as follows;
(xn,yn,znnnn)(xe,ye,zeeee)−(xt,yt,ztttt)
Where the subscript “n” denotes the “Zero Position” coordinates.
The right most flow chart 1150 in FIG. 11 describes an example of how the intelligent positioning system determines the desired position of the end effector during a surgical procedure and using the “Zero Position” coordinate. The first step 1160 is to prompt the intelligent positioning system to realign the end effector in the zero position. The next step 1170 is to acquire the spatial position and pose of the target in the common coordinate frame. In the same step it stores this spatial position and pose as coordinates, for example shown as follows;
(xt,yt,ztttt)
The following step 1180 is to add the “Zero Position” coordinates to the target coordinates to obtain the “desired position of the end effector” coordinates. For example as shown as follows;
(xd,yd,zdddd)(xt,yt,ztttt)+(xn,yn,znnnn)
Where the subscript “d” denotes the “desired position of the end effector” coordinates. The final step 1190 is to import these coordinates into the common coordinate frame to define to the desired end effector spatial position and pose.
Manual Port Alignment
During an access port procedure, aligning the orientation of the access port for insertion, and ensuring the access port remains in alignment through the cannulation step (as described in more detail below) can be a crucial part of a successful procedure. Current navigation systems provide a display to facilitate this alignment. Some navigation systems are designed to only ensure alignment to the surgical area of interest point regardless of trajectory, while others ensure alignment of a specific trajectory to surgical area of interest point. In any case, this information is displayed on the navigation screen, detached from the view of the actual medical instrument the surgeon is manipulating. With these systems it is often necessary to have a second operator focus on the screen and manually call out distance and orientation information to the surgeon while the surgeon looks at the instrument he is manipulating.
In some embodiments, an alignment device is rigidly and removably connected to the access port, and may also be employed as an alignment mechanism for use during video-based alignment.
FIG. 12B illustrates an example implementation for aligning an access port based on visual feedback in imaging provided by an external imaging device aligned with the desired trajectory of interest. Conical device 1205 is rigidly and removably attached to access port 1230 with its tip 1225 aligned along the axis of the access port with circular annotations 1215 printed at various depths. When the access port is viewed using an external imaging device with the axis of the external imaging device aligned along the intended insertion path, the circular markers 1215 will appear concentric as shown in FIG. 12B (iii) and (iv). A misaligned access port will result in the circular markers not appearing in concentric fashion. An example of such misalignment is shown in FIG. 12B (ii). Further, a virtual cross-hair 1265 may be displayed on a screen to aid a surgeon to coaxially align the access port while viewing the access port through an externally positioned imaging device. The position of the virtual cross-hair can be based on pre-operative surgical planning and can be the optimal path for inserting the surgical access port for minimizing trauma to the patient.
FIG. 12A illustrates another example implementation in which two or more alignment markers 1210 are provided at different depths along the axis of the access port 1230, optionally with a cross on each alignment marker. These alignment markers can be provided with increasing diameter as the distance increases relative to the imaging device, so that the alignment markers are visible even if partially occluded by nearer alignment markers. In this embodiment, the correct alignment would be indicated by an alignment of all the markers within the annotated representation of the markers, as shown in see FIG. 12A (iii) and (iv).
In one example embodiment, the alignment markers can be provided with a colored edge 1240 that if visible on the imaging device feed, would indicate that the alignment is off axis, as shown in FIG. 12A (ii). The video overlay may also include a display of the depth to the target plane so that the insertion distance can be seen by the surgeon on the same screen as the targeting overlay and the video display of the surgical field.
Modes of Function
In a preferred embodiment the automated arm of the intelligent positioning system will function in various modes as determined but not limited by the surgeon, the system, the phase of surgery, the image acquisition modality being employed, the state of the system, the type of surgery being done (e.g. Port based, open surgery, etc.), the safety system. Further the automated arm may function in a plurality of modes which may include following mode, instrument tracking mode, cannulation mode, optimal viewing mode, actual actuation mode, field of view mode, etc.
The following is a brief summary of some of the modes mentioned above:
Following Mode:
In following mode the automated arm will follow the target at the predetermined (chosen) spatial position and pose as the target is manipulated by the surgeon (for example in the manner illustrated in FIGS. 16C-D and described in detail above), either through electronic or physical means. For the case of the port based surgery commonly used for tumor resection as mentioned above, the surgeon will manipulate the port within the patient's brain as they search for tumor tissue 120 to resect. As the port is manipulated the automated arm mounted with the imaging device will move to consistently provide a constant field of view down the port with lighting conditions geared towards tissue differentiation. This mode can be employed with restrictions to assure that no contact of the arm is made with any other instrument or personnel including the surgeon within the operating room by the process described in the description of FIG. 6C. This restriction can be achieved using proximity sensors to detect obstacles or scene analysis of images acquired for the operating room as described below in greater detail. In addition the surgeon can either dictate the chosen (zero position) spatial position and pose of the arm (including the Imaging device) relative to the target or it can be determined automatically by the system itself through image analysis and navigational information.
Some alternate derivative embodiments of following mode may include
    • In anti-jitter mode the imaging sensor vibration is compensated for, through the use of various methods such as actuation of magnetic lens, stability coils as well as by slowing the movement of the arm. The jitter can be detected using image analysis software and algorithms as available in the industry today. An example of an anti-jitter mechanism is provided in the patent [U.S. Pat. No. 6,628,711 B1: Method and apparatus for compensating for jitter in a digital video image]
    • In delayed following mode the arm is adjusted to assure the predetermined (zero position) spatial position and pose of the imaging device is kept constant, but the following movement has a delay to reduce the probability of minor undeliberate movements of the target (the port 100 in the case of port based surgery)
      Instrument Tracking Mode:
In instrument tracking mode the automated arm can adjust the imaging device to follow the medical instruments used by the surgeon, by either centering the focus or field of view and any combination thereof on one instrument, the other instrument, or both instruments. This can be accomplished by uniquely identifying each tool and modelling them using specific tracking marker orientations as described above.
Cannulation Mode:
In cannulation mode the automated arm adjusts the imaging device to an angle which provides an improved view for cannulation of the brain using a port. This would effectively display a view of the depth of the port and introducer as it is inserted into the brain to the surgeon
Optimal Viewing Mode:
Given the images captured by the imaging device an optimal viewing mode can be implemented where an optimal distance can be obtained and used to actuate the automated arm into a better viewing angle or lighting angle to provide maximized field of view, resolution, focus, stability of view, etc. as required by the phase of the surgery or surgeon preference. The determination of these angles and distances within limitations would be provided by a control system within the intelligent positioning system. The control system is able to monitor the light delivery and focus on the required area of interest, given the optical view (imaging provided by the imaging sensor) of the surgical site, it can then use this information in combination with the intelligent positioning system to determine how to adjust the scope to provide the optimal viewing spatial position and pose, which would depend on either the surgeon, the phase of surgery, or the control system itself.
Actuation Mode:
Additional modes would be actuation mode in which case the surgeon has control of the actuation of the automated arm to align the imaging device with the target in a chosen spatial position and pose and at a pre-set distance. In this way the surgeon can utilize the target (If a physical object) as a pointer to align the imaging device in whatever manner they wish (useful for open surgery) to optimize the surgery which they are undertaking.
Field of View Mode:
In field of view mode the automated arm in combination with the imaging device can be made to zoom on a particular area in a field of view of the image displayed on the surgical monitor. The area can be outlined on the display using instruments which would be in the image or through the use of a cursor controlled by a personnel in the operating room or surgeon. Given the surgeon has a means of operating the cursor. Such devices are disclosed in US Patents.
Combination of Modes:
The modes mentioned above and additional modes can be chosen or executed by the surgeon or the system or any combination thereof, for example the instrument tracking mode and optimal lighting mode can be actuated when the surgeon begins to use a particular tool as noted by the system. In addition the lighting and tracking properties of the modes can be adjusted and made to be customized to either each tool in use or the phase of the surgery or any combination thereof. The modes can also be employed individually or in any combination thereof for example the Raman mode in addition to the optical view mode. All of the above modes can be optionally executed with customized safety systems to assure minimization of failures during the intra-operative procedure.
Optimization of View at End of Port
In the context of an imaging device formed as a camera imaging device with a configurable illumination source, supported by the automated arm, alignment with the access port may be important for a number of reasons, such as, the ability to provide uniform light delivery and reception of the signal. In addition, auto-focus of the camera to a known location at the end of the access port may be required or beneficial.
In some implementations, the present embodiments may provide for accurate alignment, light delivery, regional image enhancement and focus for external imaging devices while maintaining an accurate position. Automated alignment and movement may be performed in coordination with tracking of the target (access port). As noted above, this may be accomplished by determining the spatial position and/or pose of the target (access port) by a tracking method as described above, and employing feedback from the tracked spatial position and/or pose of the external imaging device when controlling the relative position and/or pose of the external imaging device using the automated arm.
In an embodiment, directional illumination device such as a laser pointer or collimated light source (or an illumination source associated with an imaging device supported by the automated arm) may be used to project.
Optical Optimization of Port
In yet a further embodiment, a calibration pattern is located at or near the proximal end of the access port. This pattern will allow the camera imaging device to automatically focus, align the orientation of its lens assembly, and optionally balance lighting as well as color according to stored values and individual settings. An exemplary method used to identify the particular type of port being used is the template matching method described above. The template 1030 shown in FIG. 10A, can be used to provide the required information about the port dimensions for optimal lighting and focus parameters that the imaging device can be configured to conform with.
Another stage of alignment may involve the camera imaging device focusing on the tissue deep within the access port, which is positioned at a known depth (given the length of the access port is known and the distance of the port (based on the template on the proximal end of the port). The location of the distal end of the access port 100 will be at a known position relative to the imaging sensor 104 of FIG. 1 and tracked access port 100, in absolute terms, with some small-expected deviation of the surface of the tissue bowing into the access port at the distal end. With a given field of view, camera optical zoom/focus factors, and a known distance from the detector to end of access port, the focus setting can be predetermined in a dynamic manner to enable auto-focus to the end of the tissue based simply on tracking of the access port and camera location, while using some known settings (camera, access port length, focus optics/mechanics, desired field of view). In this manner, a stable focus can be established to maximize the desired field of view.
In a similar, closed-loop manner, color and white balance of the imaging device output can be determined through suitable imaging processing methods. A significant issue with current surgical optics is glare caused by fluids reflecting the intense illumination in the surgical cavity. The glare causes imbalance in the dynamic range of the camera, where the upper range of the detectors dynamic range is saturated. In addition, the illumination intensity across the frequency spectrum can be unbalanced depending on the illumination and surgical conditions. By using a combination of calibration features or targets on the access port (100), and using pre-set parameters associated with the combination of camera and light source, the images can be analyzed to automatically optimize the color balance, white balance, dynamic range and illumination uniformity (spatial uniformity). Several published algorithms may be employed to automatically adjust these image characteristics. For example, the algorithm published by Jun-yan Huo et. al. (“Robust automatic white balance algorithm using gray color points in images,” IEEE Transactions on Consumer Electronics, Vol. 52, No. 2, May 2006) may be employed to achieve automatic white balance of the captured video data. In addition, the surgical context can be used to adapt the optimal imaging conditions. This will be discussed in greater detail below.
Two Stage Method Image Optimization
Alternatively, in a two-step approach, the tracking system can be employed, in a first step of alignment, to track the position of the access port, for a gross calculation of spatial position and pose. This allows for an imaging device 104, as seen in FIG. 1, to be positioned in a co-axial manner relative to the port 100, and at the appropriate focal distance and focal setting based on the field of view, resolution, and frame rate, defined by the user. This will only be accurate within the tolerance of the tracking capability of the system, the mechanical positioning accuracy of the automated arm, and the tissue deflection at the tip of the access port.
A second stage alignment, based on imaging optimization and focus, can optionally be achieved by interaction of the imaging sensor, positioning of the automated arm, analysis of the images, and the use of range detection to the end of the access port (for example by template matching), and centered at the distal end of the access port. For example, as is currently done with more traditional auto-focus functions of digital camera systems, the image can be analyzed to determine the sharpness of the image by way of image metric quantification in a series of focal zones. The focal zones would be directed to a location at the end of the access port, where the gross positioning of the system would allow for this fine, and more focused approach to automatically detect the focal zone as being within the field of view of the end of the access port. More specifically, this is defined as a zone smaller than the field of view of the access port.
In addition, one or more range detectors can be used, optionally through the lens of the imaging device 104, so that the actual position of the tissue at the end of the access port can be calculated. This information can be provided as input into the iterative algorithm that determines the optimal imaging device position, and focal settings.
Optimized Illumination and Data
The coaxial alignment of the imaging sensor with the access port, enables efficient light delivery to the end of the access port which is vital to acquiring higher resolution imaging, as well as the ability to focus optics so as to enhance or maximize the detector efficiency. For instance, with a poorly aligned access port and imaging sensor, only a small fraction of the imaging sensor is utilized for imaging of the area of interest, i.e. the end of the access port. Often only 20% of the total detector is used, while a properly aligned imaging sensor can yield 60%+detector efficiency. An improvement from 20% to 60% detector efficiency roughly yields an improved resolution of 3 times. A setting can be established on the system to define a desired efficiency at all times. To achieve this, the intelligent positioning system will actuate the movement of the automated arm, mounted with the imaging sensor, and focus it at the distal end of the access port as it is maneuvered by the surgeon to achieve the desired detector efficiency, or field of view.
Homgenized Light Delivery
Another advantageous result of this embodiment is the delivery of homogenized light through the port to the surgical area of interest permitting improved tissue differentiation between healthy and unhealthy brain tissue by potentially reducing glare and reducing shadows which fall on the tissue due to the port. For example the intelligent positioning system can utilize light ray tracing software (such as ZMAX) to model the system given the constraints of the spatial position, pose and 3D virtual model of the port as well as the spatial position, pose and model illumination source as shown in FIG. 13. The first model 1310 shows the illumination of the region of interest using a single illumination element on the external imaging device at a given distance and pose relative to the port. The second 1320 and third 1330 models show illumination of the region of interest using illumination from two sources each. The pairs of sources in each model are oriented differently with respect to the other model. Both models two and three have the same distance and pose parameters as model one relative to the port. The final model 1340 shows illumination from two sources with the same orientation as the sources in the second model 1320 relative to the imaging device, with the same pose but, a different distance. The color map on each region of interest (distal end of the port) shown in the figure describes the illumination level, where mid-range 1350 represents the ideal illumination level.
As can be seen in FIG. 13, hot spots 1360 exist in models one through three (1310, 1320, 1330) which result in heavy glare at those positions and inadequate imaging for the surgeon, while model four 1340 provides the optimal lighting condition (homogenized and low glare delivery of illumination). Using model four as the optimal spatial position and pose alignment of the illumination source, the automated arm would position the imaging sensor (inclusive of the illumination source) to achieve this particular illumination level map thereby improving the view of the surgical area of interest for the surgeon. The software can then determine the optimal spatial position and pose of the illumination source (the Imaging device in this case) relative to the target (port) given the restrictions of the system (minimum offset 575 as shown in FIG. 6A-B) to ensure optimal light delivery through the port to the region of interest. The illumination source may be also optimally positioned after modelling the shadow cast by the surgical tools. In other words, the target region within the field of view may be optimally illuminated while avoiding casting of shadows from the medical instruments utilized by the surgeon within the port. This is possible given the spatial position and pose of the medical instrument can be estimated using tracking markers placed on the surgical tools.
Referring now to FIGS. 14A and 14B, a block diagram of an example system configuration is shown. The example system includes control and processing system 1400 and a number of external components, shown below.
As shown in FIG. 14A, in one embodiment, control processing system 1400 may include one or more processors 1402, a memory 1404, a system bus 1406, one or more input/output interfaces 408, a communications interface 1410, and storage device 1412. Processing and control system 1400 is interfaced with a number of external devices and components, including, for example, those associated with access port imaging and tracking, namely motor(s) 1420, external imaging device(s) 1422, projection and illumination device(s) 1424, and automated arm 1426. External user input and user interface rendering is facilitated by one or more displays 1430 and one or more external input/output devices 1426 (such as, for example, a keyboard, mouse, foot pedal, microphone and speaker).
Processing and control system 1400 is also interfaced with an intelligent positioning system 1440 inclusive of a tracking device 113 for tracking items such as an access port 100 in Figure or 1450 in FIG. 14 and one or more devices or instruments 1452. Additional optional components include one or more therapeutic devices 1442 that may be controlled by processing and control system 1400, and external storage 1444, which may be employed, for example, for storing pre-operative image data, surgical plans, and other information.
It is to be understood that the system is not intended to be limited to the components shown in FIG. 1400. One or more components control and processing 1400 may be provided as an external component that is interfaced to a processing device. In one alternative embodiment, navigation system 1440 may be integrated directly with control and processing system 1400.
Embodiments of the disclosure can be implemented via processor 1402 and/or memory 1404. For example, the functionalities described herein can be partially implemented via hardware logic in processor 1402 and partially using the instructions stored in memory 1404, as one or more processing engines. Example processing engines include, but are not limited to, statics and dynamics modeling engine 1458, user interface engine 1460, tracking engine 1462, motor controller 1464, computer vision engine 1466, engine to monitor surrounding environment of the automated arm based on sensor inputs 1431, image registration engine 1468, robotic planning engine 1470, inverse kinematic engine 1472, and imaging device controllers 1474. These example processing engines are described in further detail below.
Some embodiments may be implemented using processor 1402 without additional instructions stored in memory 1404. Some embodiments may be implemented using the instructions stored in memory 1404 for execution by one or more general purpose microprocessors. Thus, the disclosure is not limited to a specific configuration of hardware and/or software.
While some embodiments can be implemented in fully functioning computers and computer systems, various embodiments are capable of being distributed as a computing product in a variety of forms and are capable of being applied regardless of the particular type of machine or computer readable media used to actually effect the distribution.
At least some aspects disclosed can be embodied, at least in part, in software. That is, the techniques may be carried out in a computer system or other data processing system in response to its processor, such as a microprocessor, executing sequences of instructions contained in a memory, such as ROM, volatile RAM, non-volatile memory, cache or a remote storage device.
A computer readable storage medium can be used to store software and data which when executed by a data processing system causes the system to perform various methods. The executable software and data may be stored in various places including for example ROM, volatile RAM, nonvolatile memory and/or cache. Portions of this software and/or data may be stored in any one of these storage devices.
It is further noted that in some embodiments, unlike a typical automated arm which has to account for unknown weight of the material picked up by the distal end, automated arm need only account for the known weight of external devices (such as imaging devices) attached to the distal end. Hence, known statics and dynamics of the entire automated arm can be modeled a priori (e.g. via engine 1458 of FIG. 14) and this knowledge can be incorporated in the accurate control of the arm during tracking. Further, imaging and tracking modalities can be used to provide situational awareness for the automated arm, as described above. This situational knowledge can be incorporated during tracking of the access port by the external device or devise supported by the arm to avoid accidental collision of the arm with obstacles in the path such as surgical team, other equipment in the operating room and the patient. This situational awareness may also arrive from proximity sensors optionally mounted on the automated arm and/or distal end, as noted above.
In one embodiment the system is configured consistently with the block diagram shown in FIG. 14B. FIG. 14B is an exemplary embodiment of the intelligent positioning system illustration utilized in connection with a navigation system. The descriptions below outline various exemplary communication paths which may be utilized throughout the intelligent positioning system (IPS).
User->Foot Pedals->Arm Controller->Positioninq Arm
The surgeon has three discrete-input pedals to control the IPS:
    • 1. Align to Tool: Pressing this pedal 155 shown in FIG. 1 will align the scope 266 to the target (such as the port 100) that is currently being tracked. The pedal 155 needs to be continuously held during the motion to the point of the tool at the time the pedal was initially depressed. The user needs to press the pedal again to realign.
    • 2. Increase Standoff: The pedal will increase the standoff distance 675 between the selected tool and the scope. The distal end will move at constant velocity while depressed. The standoff distance can be increased until reach limits of the automated arm are obtained.
    • 3. Decrease Standoff: This pedal decreases the standoff distance 675, at a constant velocity, of the distal end and the selected tool. This motion will cease once a minimum standoff distance is reached (dependent upon scope and tool selected).
These pedals are connected to the digital inputs on the automated arm through the intelligent positioning system 250. The automated arm controller sends joint-level commands to the motor drivers in the automated arm.
These foot-pedals may be enhanced to include Optics control as well.
User->Touch Screen->UI Computer->Arm Controller
The user can interface with the robot through a touch screen monitor. These are generally done prior to surgery.
    • 1. Initialize the joints: As the robot arm only has relative encoders, each joint must be moved up to 20 degrees for the system to determine its absolute position. The UI provides an initialization screen in which the user moves each joint until the encoders are initialized.
    • 2. Selection of imaging sensor: Selection of imaging sensor on the UI computer gets sent to the automated arm controller. The different imaging sensors have different masses, and different desired relative spatial positions and poses relative to the target (for example the port).
    • 3. Selection of tracked medical instrument: Selection of which target to track (given multiple targets, for example a port or a medical instrument or etc.) on the UI computer gets sent to the automated arm controller.
    • 4. Degree of Freedom Selection: The user can select if the tool will be tracked in 6-, 5- or 3-DoF mode.
    • 5. Set 0 position: Set a new spatial position and pose of the automated arm (and consequently the imaging sensor given it is mounted on the automated arm) with respect to a target (for example the port)
      NDI Optical Tracker->UI Computer->Arm Controller
The NDI tracking system acquires the distal end (or equivalently the imaging sensor) spatial position and pose within its field of view. It sends this data to the UI Computer which shares the tracked target and distal end information with the automated arm controller so that the spatial position and pose can be calculated. It may also use the patient reference and registration to determine a no-access zone.
Situational Awareness Camera->UI Computer->Monitor
The situational awareness camera (specific embodiment of an imaging sensor) provides imaging of the surgical site. This imaging is sent to the UI computer which turns them into a video stream which is output to an external monitor. As well, the UI computer may overlay warnings, error messages or other information for the user on the video stream.
Phases of Port Based Surgery
An example phase breakdown of the port based surgical operation is shown in FIG. 15. The arm can be utilized in a corresponding manner to each of the phases to compliment and ease the surgeons process during each step.
    • The first step (1510) is the incision of the scalp and craniotomy. During these procedures the automated arm (102) (connected to the imaging device (104)) can be implemented to guide the surgeon to the correct position of the craniotomy with respect to the brain within the skull automatically. This is achievable through the use of the navigation system conjointly with the automated arm.
    • Once the incision and craniotomy are completed the surgery enters the next phase (1520) and the automated arm can be used to perform an US above the dura either automatically by the system or manually by the surgical team. Using this information and input from the intelligent positioning system the automated arm (with mounted imaging device) can project the sulci onto the dura to allow for a better guidance of the dura incision and increased orientation awarness. After the dura incision the cannulation process begins. In this subphase the automated arm can be adjusted to an alternate angle to provide a view of the graduation marks on the port whilst its being cannulated into the brain so the surgeon can see its depth.
    • In the next simultaneous phases (1530 and 1540) the automated automated arm 102 has the most utility as it aids in providing clear images of the distal end of the port for gross de-bulking of unhealthy brain tissue. During this step the surgeon 201 will maneauver the port 100 in the brain of the patient 202 through a multiplicity of motions (for example 1665 in FIG. 16C) to resect the tumor (120), as the distal end of the port in most cases does not provide the access needed to resect the entire tumor in one position an example of this is shown in FIG. 16C as the unaccessible part of the tumor 1680. As the port is maneavuvered the automated arm (with connnected imaging device) can follow the port in a coaxial manner to consistently provide a view of the distal end (for example as shown in FIG. 6A-B) where the surgeons tools (for example (1612)) are operating, an example flow of the constant alignment of the automated automated arm and connected scope is provided in FIG. 8B. This saves the surgeon and surgical team time and streamlines the surgical process by preventing the surgical team from having to constantly readjust the imaging device to view down the port at the correct angle to provide the required surgical view as is required in present surgical systems such as the UniArm Surgical Support System (by Mitaka USA Inc.). This also increases the accuracy of the surgeon by keeping the display of the surgical site in the same direction (relative to brain anatomy or any other reference) resulting in the surgeon remaing directionally oriented with the surgical site of operation. Another way the automated arm (as part of the intelligent positioning system) increases accuracy is by removing the need for the surgeon to reorient himself with the space (inside the brain) when working as a result of removing their instruments and readjusting the imaging sensor which is combined manually to an adjustable arm. In addition the automated arm can also align the illumination device (connected to either the distal end, or the imaging sensor) in orientations to provide ideal lighting to the distal end of the port. In this phase the automated arm can also perform other alignment sequences required for other imaging modalities for example, stereoscopic imaging as described above for 3D imaging. The automated attainment of stereoscopic images can readily provide more information to the surgeon again increasing their accuracy during the procedure. The automated arm 102 can also provide other imaging modalities through the use of imaging probes by automated insertion into the port or automated external scanning as required by the surgeon or determined by the navigation system in combination with the intelligent positioning system.
    • After the bulk resection phase the surgical procedure enters the next two simultaneous phases of fine-resection (1550 and 1560). In this phase the surgeon removes the tumor from the fringes of healthy tissue, by differentitiating, using their knowledge, between the healthy and unhealthy tissue. During fine-resection the automated arm is used in a similar manner to the gross debulking phase above.
    • The next phase of surgery (1570) could potentially require the automated arm to deliver therapeautic agents to the surgical site to remove any remaining unhealthy tissue from the area and assure an optimal recovery. This step can be accomplished by the navigation system in combination with the intelligent positioning system and its maneuvering of the automated arm down the port to the correct site where a therapeutic distal end instrument could be used to supply the therapeutics. In addition the arm could possibly be provided the ability to maneauvre the port as required to achieve effective delivery to all sites automatically based on inputs provided by the navigation system and/or the surgeon.
    • The final step (1580) involves the removal of the port and closure of the wound in addition to the application of materials to assist in healing the surgical area. In this step the automated arm is used in a similar manner to the gross de-bulking step in that the automated maneuvering of the arm by the system follows the surgeons surgical tool to provide the required view.
Once the port is removed the automated arm is maneuvered in a similar manner to the incision step providing the correct view of the surgical area during the suturing of the wound.
In another embodiment the intelligent positiong system can be provided with presurgical information to improve arm function. Examples of such information are a system plan indicating the types of movements and adjustments required for each stage of surgery as well as the operating theater instruments and personnel positioning during the phases of surgery. This would streamline the surgical process by reducing the amount of manual and customized adjustments dictated by the surgeon throughout the procedure. Other information such as the unique weights of the imaging sensors can be inputted to assure a smooth movement of the arm by automatic adjustment of the motors used to run it.
Singularities
The American National Standard for Industrial Robots and Robot Systems—Safety Requirements (ANSI/RIA R15.06-1999) defines a singularity as “a condition caused by the collinear alignment of two or more robot axes resulting in unpredictable robot motion and velocities.” It is most common in robot arms that utilize a “triple-roll wrist”. This is a wrist about which the three axes of the wrist, controlling yaw, pitch, and roll, all pass through a common point. An example of a wrist singularity is when the path through which the robot is traveling causes the first and third axes of the robot's wrist (i.e. robot's axes 4 and 6) to line up. The second wrist axis then attempts to spin 360° in zero time to maintain the orientation of the end effector. Another common term for this singularity is a “wrist flip”. The result of a singularity can be quite dramatic and can have adverse effects on the robot arm, the end effector, and the process. Some industrial robot manufacturers have attempted to side-step the situation by slightly altering the robot's path to prevent this condition. Another method is to slow the robot's travel speed, thus reducing the speed required for the wrist to make the transition. The ANSI/RIA has mandated that robot manufacturers shall make the user aware of singularities if they occur while the system is being manually manipulated.
A second type of singularity in wrist-partitioned vertically articulated six-axis robots occurs when the wrist center lies on a cylinder that is centered about axis 1 and with radius equal to the distance between axes 1 and 4. This is called a shoulder singularity. Some robot manufacturers also mention alignment singularities, where axes 1 and 6 become coincident. This is simply a sub-case of shoulder singularities. When the robot passes close to a shoulder singularity, joint 1 spins very fast.
The third and last type of singularity in wrist-partitioned vertically articulated six-axis robots occurs when the wrist's center lies in the same plane as axes 2 and 3.
Self-Collision and Singularity Motion Interlock
Having the automated arm be mobile instills another constraint on the intelligent positioning system, which is to ensure the mobile base and the automated arm are not simultaneously in motion at any given time. This is accomplished by the system by having an auto-locking mechanism which applies brakes to the arm if the wheel brakes for the mobile base are not engaged. The reasoning for this constraint is movement of the arm without a static base will result in motion of the base (basic physics). If the arm is mounted on a vertical lifting column, the lifting column adds to this constraint set: the lifting column cannot be activated if the mobile base wheels are not braked or if the arm is in motion. Similarly, the arm cannot be moved if the lifting column is active. If the mobile base wheel brakes are released, the arm and lifting column are both disabled and placed in a braked state.
Additional Mode Constraints
Consider adding—it only moves in regard to a parameter based on
    • the image—for example if the percentage of the image from the bottom of the port is least a certain percentage of the total image—or some relevant parameter
    • the axial alignment—for example it moves if it is off co-axial by certain degrees greater than x
      Closing Statements (Non-Limitations of Draft
Accordingly, in some embodiments of the present disclosure, system, devices and methods are described that employ imaging devices, guidance devices, tracking devices, navigation systems, software systems and surgical tools to enable a fully integrated and minimally invasive surgical approach to performing neurological and other procedures, such as previously inoperable brain tumors, in addition to the intracranial procedure using the port based method described above. It is to be understood, however, that the application of the embodiments provided herein is not intended to be limited to neurological procedures, and may be extended to other medical procedures where it is desired to access tissue in a minimally invasive manner, without departing from the scope of the present disclosure. Non-limiting examples of other minimally invasive procedures include colon procedures, spinal, orthopedic, open, and all single-port laparoscopic surgery that require navigation of surgical tools in narrow cavities. The specific embodiments described above have been shown by way of example, and it should be understood that these embodiments may be susceptible to various modifications and alternative forms. It should be further understood that the claims are not intended to be limited to the particular forms disclosed, but rather to cover all modifications, equivalents, and alternatives falling within the spirit and scope of this disclosure.
While the teachings described herein are in conjunction with various embodiments for illustrative purposes, it is not intended that the applicant's teachings be limited to such embodiments. On the contrary, the applicant's teachings described and illustrated herein encompass various alternatives, modifications, and equivalents, without departing from the embodiments, the general scope of which is defined in the appended claims.

Claims (20)

What is claimed is:
1. An automated arm assembly for use during a medical procedure on an anatomical part, the automated arm assembly comprising:
a base frame;
a multi-joint arm operably connected to the base frame and having a distal end that is detachably connectable to an end effector;
an optical imaging device mounted on the end effector;
a weight operably connected to the base frame that provides a counterweight to the multi-joint arm;
a positioning control system operably connected to the multi-joint arm and which is also connectable to a surgical navigation system which is configured to provide information relating to a position of a target, said control system configured to receive input from said surgical navigation system;
the positioning control system configured for, based on input from said surgical navigation system:
identifying a position and an orientation for the target in a predetermined coordinate frame with respect to the anatomical part;
obtaining a position and an orientation of the optical imaging device mounted on the automated arm being located outside and spaced away from the anatomical part and the target, the position and orientation of the optical imaging device being defined in the predetermined coordinate frame;
obtaining a desired standoff distance and a desired orientation between the target and the optical imaging device;
instructing the multi-joint arm to move the optical imaging device to the desired standoff distance and desired orientation;
upon movement of the target, determining a new desired standoff distance and a new desired orientation between the optical imaging device and the preselected portion of the target such that a preselected portion of the target is located in a field of view of the optical imaging device; and
instructing the multi-joint arm to move the optical imaging device to the new desired standoff distance and desired orientation.
2. The automated arm assembly according to claim 1 further including a tower attached to the base frame and extending upwardly therefrom, the multi-joint arm is attached to the tower and extends outwardly therefrom.
3. The automated arm assembly according to claim 2 wherein the arm is movably upwardly and downwardly on the tower.
4. The automated arm assembly according to claim 1 further comprising a supporting beam with one end movably attached to the tower and the other end to the automated arm.
5. The automated arm assembly according to claim 1 wherein the multi-joint arm has at least six degrees of freedom.
6. The automated arm assembly according to claim 1 wherein the automated arm assembly may be moved manually.
7. The automated arm assembly according to claim 1 wherein the base frame further includes wheels.
8. The automated arm assembly according to claim 1 wherein the end effector is tracked using the detection system.
9. The automated arm assembly according to claim 1 wherein multi-joint arm further includes tracking markers which are tracked using the detection system.
10. The automated arm assembly according to claim 1 further including a radial arrangement attached to the distal end of the multi-joint arm and the end effector is movable attached to the radial arrangement whereby the end effector moves along the radial arrangement responsive to information from the control system.
11. The automated arm assembly according to claim 1 further including a joy stick operably connected to the control system and movement of the multi-joint arm is controllable by the joy stick.
12. The automated arm assembly according to claim 1 wherein the end effector is one of an external video scope, an abrasion laser, a gripper, an insertable probe or a micromanipulator.
13. The automated arm assembly according to claim 1 wherein the end effector is a first end effector and further including a second end effector attachable proximate to the distal end of the multi-joint arm.
14. The automated arm assembly according to claim 13 wherein the second end effector is wide angle camera.
15. The automated arm assembly according to claim 1 wherein the control system constrains the movement of the multi-joint arm based on defined parameters.
16. The automated arm assembly according to claim 15 wherein the defined parameters include space above patient, floor space, maintaining surgeon line of sight, maintaining tracking camera line of sight, mechanical arm singularity, self-collision avoidance, patient collision avoidance, base orientation, and a combination thereof.
17. The automated arm assembly according to claim 1 further including a protective dome attached to the multi-joint arm and the distal end of the multi-joint arm is constrained to move only within the protective dome.
18. The automated arm assembly according to claim 1 wherein a virtual safety zone is defined by the control system and the distal end of the multi-joint arm is constrained to move only within the safety zone.
19. The automated arm assembly according to claim 1 wherein the control system is configured for, upon determining a new desired standoff distance and a new desired orientation between the imaging device and the preselected portion of the target, calculating a desired focus and zoom level for the imaging device and adjusting the focus and zoom level of the imaging device to the desired focus and zoom level when the imaging device is moved to the new desired standoff distance and new orientation.
20. The automated arm assembly according to claim 19 including a visual display, and wherein the control system is configured to display an image of the preselected portion of the target at the desired focus and zoom level of the imaging device.
US14/655,872 2013-03-15 2014-03-14 Intelligent positioning system and methods therefore Active US9668768B2 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
US14/655,872 US9668768B2 (en) 2013-03-15 2014-03-14 Intelligent positioning system and methods therefore
US15/480,648 US11103279B2 (en) 2013-03-15 2017-04-06 Intelligent positioning system and methods therefor

Applications Claiming Priority (12)

Application Number Priority Date Filing Date Title
US201361801143P 2013-03-15 2013-03-15
US201361801746P 2013-03-15 2013-03-15
US201361801530P 2013-03-15 2013-03-15
US201361800155P 2013-03-15 2013-03-15
US201361800695P 2013-03-15 2013-03-15
US201361818255P 2013-05-01 2013-05-01
US201361818280P 2013-05-01 2013-05-01
US201361818325P 2013-05-01 2013-05-01
US201361818223P 2013-05-01 2013-05-01
US201461924993P 2014-01-08 2014-01-08
US14/655,872 US9668768B2 (en) 2013-03-15 2014-03-14 Intelligent positioning system and methods therefore
PCT/CA2014/050271 WO2014139023A1 (en) 2013-03-15 2014-03-14 Intelligent positioning system and methods therefore

Related Parent Applications (1)

Application Number Title Priority Date Filing Date
PCT/CA2014/050271 A-371-Of-International WO2014139023A1 (en) 2013-03-15 2014-03-14 Intelligent positioning system and methods therefore

Related Child Applications (1)

Application Number Title Priority Date Filing Date
US15/480,648 Division US11103279B2 (en) 2013-03-15 2017-04-06 Intelligent positioning system and methods therefor

Publications (2)

Publication Number Publication Date
US20160113728A1 US20160113728A1 (en) 2016-04-28
US9668768B2 true US9668768B2 (en) 2017-06-06

Family

ID=51535740

Family Applications (4)

Application Number Title Priority Date Filing Date
US14/655,872 Active US9668768B2 (en) 2013-03-15 2014-03-14 Intelligent positioning system and methods therefore
US15/480,648 Active 2037-02-17 US11103279B2 (en) 2013-03-15 2017-04-06 Intelligent positioning system and methods therefor
US15/861,889 Active 2036-12-26 US11207099B2 (en) 2013-03-15 2018-01-04 Intelligent positioning system and methods therefor
US17/456,500 Pending US20220087711A1 (en) 2013-03-15 2021-11-24 Intelligent positioning system and methods therefore

Family Applications After (3)

Application Number Title Priority Date Filing Date
US15/480,648 Active 2037-02-17 US11103279B2 (en) 2013-03-15 2017-04-06 Intelligent positioning system and methods therefor
US15/861,889 Active 2036-12-26 US11207099B2 (en) 2013-03-15 2018-01-04 Intelligent positioning system and methods therefor
US17/456,500 Pending US20220087711A1 (en) 2013-03-15 2021-11-24 Intelligent positioning system and methods therefore

Country Status (10)

Country Link
US (4) US9668768B2 (en)
EP (1) EP2967348B1 (en)
CN (1) CN105050527B (en)
AU (1) AU2014231345B2 (en)
BR (1) BR112015023547B8 (en)
CA (3) CA2896381C (en)
HK (1) HK1216706A1 (en)
MY (1) MY170323A (en)
SG (1) SG11201507613QA (en)
WO (1) WO2014139023A1 (en)

Cited By (26)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20160199141A1 (en) * 2014-12-23 2016-07-14 Philip Mewes Operating a medical-robotic device and a medical-robotic device
US20170252921A1 (en) * 2014-11-25 2017-09-07 Kai HYNNA Hand-guided automated positioning device controller
US9828433B2 (en) 2010-11-15 2017-11-28 Novartis Ag Nucleic acids encoding silent Fc variants of anti-CD40 antibodies
US10136954B2 (en) * 2012-06-21 2018-11-27 Globus Medical, Inc. Surgical tool systems and method
DE102018205758A1 (en) * 2018-04-16 2019-10-17 Siemens Healthcare Gmbh Medical device and method for operating a medical device
WO2020131186A1 (en) * 2018-12-20 2020-06-25 Auris Health, Inc. Systems and methods for robotic arm alignment and docking
US10798321B2 (en) 2017-08-15 2020-10-06 Dolby Laboratories Licensing Corporation Bit-depth efficient image processing
US10959792B1 (en) 2019-09-26 2021-03-30 Auris Health, Inc. Systems and methods for collision detection and avoidance
US11033341B2 (en) 2017-05-10 2021-06-15 Mako Surgical Corp. Robotic spine surgery system and methods
US11065069B2 (en) 2017-05-10 2021-07-20 Mako Surgical Corp. Robotic spine surgery system and methods
US11103279B2 (en) * 2013-03-15 2021-08-31 Synaptive Medical Inc. Intelligent positioning system and methods therefor
US11114199B2 (en) 2018-01-25 2021-09-07 Mako Surgical Corp. Workflow systems and methods for enhancing collaboration between participants in a surgical procedure
US11197728B2 (en) 2018-09-17 2021-12-14 Auris Health, Inc. Systems and methods for concomitant medical procedures
US11234780B2 (en) 2019-09-10 2022-02-01 Auris Health, Inc. Systems and methods for kinematic optimization with shared robotic degrees-of-freedom
US11298195B2 (en) 2019-12-31 2022-04-12 Auris Health, Inc. Anatomical feature identification and targeting
US11338445B2 (en) * 2017-08-28 2022-05-24 Macdonald, Dettwiler And Associates Inc. End effector force sensor and manual actuation assistance
US11357586B2 (en) 2020-06-30 2022-06-14 Auris Health, Inc. Systems and methods for saturated robotic movement
US11369448B2 (en) 2019-04-08 2022-06-28 Auris Health, Inc. Systems, methods, and workflows for concomitant procedures
US20230063233A1 (en) * 2017-08-25 2023-03-02 Novasignal Corp. Portable headset
US11602402B2 (en) 2018-12-04 2023-03-14 Globus Medical, Inc. Drill guide fixtures, cranial insertion fixtures, and related methods and robotic systems
US11602372B2 (en) 2019-12-31 2023-03-14 Auris Health, Inc. Alignment interfaces for percutaneous access
US11660147B2 (en) 2019-12-31 2023-05-30 Auris Health, Inc. Alignment techniques for percutaneous access
US11744670B2 (en) 2018-01-17 2023-09-05 Auris Health, Inc. Surgical platform with adjustable arm supports
US11839969B2 (en) 2020-06-29 2023-12-12 Auris Health, Inc. Systems and methods for detecting contact between a link and an external object
US11857277B2 (en) 2019-02-08 2024-01-02 Auris Health, Inc. Robotically controlled clot manipulation and removal
US11931901B2 (en) 2021-06-23 2024-03-19 Auris Health, Inc. Robotic medical system with collision proximity indicators

Families Citing this family (237)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2012049623A1 (en) 2010-10-11 2012-04-19 Ecole Polytechnique Federale De Lausanne (Epfl) Mechanical manipulator for surgical instruments
JP5715304B2 (en) 2011-07-27 2015-05-07 エコール ポリテクニーク フェデラル デ ローザンヌ (イーピーエフエル) Mechanical remote control device for remote control
US11871901B2 (en) 2012-05-20 2024-01-16 Cilag Gmbh International Method for situational awareness for surgical network or surgical network connected device capable of adjusting function based on a sensed situation or usage
US11793570B2 (en) 2012-06-21 2023-10-24 Globus Medical Inc. Surgical robotic automation with tracking markers
US11317971B2 (en) 2012-06-21 2022-05-03 Globus Medical, Inc. Systems and methods related to robotic guidance in surgery
US11589771B2 (en) 2012-06-21 2023-02-28 Globus Medical Inc. Method for recording probe movement and determining an extent of matter removed
US11298196B2 (en) 2012-06-21 2022-04-12 Globus Medical Inc. Surgical robotic automation with tracking markers and controlled tool advancement
US11253327B2 (en) 2012-06-21 2022-02-22 Globus Medical, Inc. Systems and methods for automatically changing an end-effector on a surgical robot
US11857149B2 (en) 2012-06-21 2024-01-02 Globus Medical, Inc. Surgical robotic systems with target trajectory deviation monitoring and related methods
US11786324B2 (en) 2012-06-21 2023-10-17 Globus Medical, Inc. Surgical robotic automation with tracking markers
US11399900B2 (en) 2012-06-21 2022-08-02 Globus Medical, Inc. Robotic systems providing co-registration using natural fiducials and related methods
US10799298B2 (en) 2012-06-21 2020-10-13 Globus Medical Inc. Robotic fluoroscopic navigation
US10624710B2 (en) 2012-06-21 2020-04-21 Globus Medical, Inc. System and method for measuring depth of instrumentation
US10758315B2 (en) 2012-06-21 2020-09-01 Globus Medical Inc. Method and system for improving 2D-3D registration convergence
US11864745B2 (en) 2012-06-21 2024-01-09 Globus Medical, Inc. Surgical robotic system with retractor
US11864839B2 (en) 2012-06-21 2024-01-09 Globus Medical Inc. Methods of adjusting a virtual implant and related surgical navigation systems
US11896446B2 (en) 2012-06-21 2024-02-13 Globus Medical, Inc Surgical robotic automation with tracking markers
US11857266B2 (en) 2012-06-21 2024-01-02 Globus Medical, Inc. System for a surveillance marker in robotic-assisted surgery
US20140005640A1 (en) 2012-06-28 2014-01-02 Ethicon Endo-Surgery, Inc. Surgical end effector jaw and electrode configurations
EP2996611B1 (en) 2013-03-13 2019-06-26 Stryker Corporation Systems and software for establishing virtual constraint boundaries
ES2763912T3 (en) * 2013-08-20 2020-06-01 Curefab Tech Gmbh Optical tracking
JP6555248B2 (en) * 2014-02-28 2019-08-07 ソニー株式会社 Medical arm device, calibration method and program
WO2015129474A1 (en) 2014-02-28 2015-09-03 ソニー株式会社 Robot arm apparatus, robot arm control method, and program
US10149618B1 (en) 2014-03-12 2018-12-11 The Board Of Regents Of The University Of Texas System Subdural electrode localization and visualization using parcellated, manipulable cerebral mesh models
GB2524498A (en) * 2014-03-24 2015-09-30 Scopis Gmbh Electromagnetic navigation system for microscopic surgery
EP3569183B1 (en) * 2014-06-20 2023-05-10 Sony Olympus Medical Solutions Inc. Medical observation apparatus and medical observation system
US9731392B2 (en) * 2014-08-05 2017-08-15 Ati Industrial Automation, Inc. Robotic tool changer alignment modules
DE102014219077A1 (en) * 2014-09-22 2016-03-24 Siemens Aktiengesellschaft Mobile medical device
WO2016058076A1 (en) * 2014-10-14 2016-04-21 Synaptive Medical (Barbados) Inc. Patient reference tool
CN111358652B (en) * 2014-10-27 2022-08-16 直观外科手术操作公司 System and method for integrated surgical table motion
CN107072727B (en) 2014-10-27 2020-01-24 直观外科手术操作公司 Medical device with active brake release control
EP3212150B1 (en) 2014-10-27 2021-08-11 Intuitive Surgical Operations, Inc. System for registering to a surgical table
CN107072725B (en) 2014-10-27 2019-10-01 直观外科手术操作公司 System and method for integrated surgical platform
CN110584789B (en) * 2014-10-27 2022-09-20 直观外科手术操作公司 System and method for instrument interference compensation
WO2016069660A1 (en) 2014-10-27 2016-05-06 Intuitive Surgical Operations, Inc. System and method for monitoring control points during reactive motion
US11504192B2 (en) 2014-10-30 2022-11-22 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11039820B2 (en) 2014-12-19 2021-06-22 Distalmotion Sa Sterile interface for articulated surgical instruments
GB2533798B (en) * 2014-12-30 2018-02-28 Gen Electric Method and system for tracking a person in a medical room
DE102015200428B3 (en) * 2015-01-14 2016-03-17 Kuka Roboter Gmbh Method for aligning a multi-axis manipulator with an input device
WO2016139512A1 (en) * 2015-03-05 2016-09-09 Synaptive Medical (Barbados) Inc. An optical coherence tomography system including a planarizing transparent material
KR20170128327A (en) * 2015-03-17 2017-11-22 인튜어티브 서지컬 오퍼레이션즈 인코포레이티드 Systems and methods for providing feedback during manual joint positioning
JPWO2016152987A1 (en) * 2015-03-25 2018-01-18 ソニー・オリンパスメディカルソリューションズ株式会社 Medical observation apparatus, surgical observation apparatus, and medical observation system
FR3036279B1 (en) * 2015-05-21 2017-06-23 Medtech Sa NEUROSURGICAL ASSISTANCE ROBOT
US9599806B2 (en) 2015-06-09 2017-03-21 General Electric Company System and method for autofocusing of an imaging system
EP3307198B1 (en) * 2015-06-10 2022-11-16 Intuitive Surgical Operations, Inc. Master-to-slave orientation mapping when misaligned
US11119171B2 (en) 2015-07-16 2021-09-14 Synaptive Medical Inc. Systems and methods for adaptive multi-resolution magnetic resonance imaging
EP3326566A4 (en) * 2015-07-23 2019-07-03 Olympus Corporation Medical system and operation method therefor
JP6177488B2 (en) 2015-07-23 2017-08-09 オリンパス株式会社 Manipulator and medical system
WO2017037532A1 (en) 2015-08-28 2017-03-09 Distalmotion Sa Surgical instrument with increased actuation force
US11033340B2 (en) * 2015-10-01 2021-06-15 Sony Corporation Medical support arm apparatus and medical system
US20190008598A1 (en) * 2015-12-07 2019-01-10 M.S.T. Medical Surgery Technologies Ltd. Fully autonomic artificial intelligence robotic system
GB201521814D0 (en) * 2015-12-10 2016-01-27 Cambridge Medical Robotics Ltd Arm location
JP6944939B2 (en) 2015-12-31 2021-10-06 ストライカー・コーポレイション Systems and methods for performing surgery on a patient's target site as defined by a virtual object
US11369436B2 (en) * 2016-01-15 2022-06-28 7D Surgical Ulc Systems and methods for displaying guidance images with spatial annotations during a guided medical procedure
EP3410941B1 (en) 2016-02-01 2021-12-29 Imaginalis S.r.l. Radiological imaging device
US11883217B2 (en) 2016-02-03 2024-01-30 Globus Medical, Inc. Portable medical imaging system and method
CA3015683C (en) * 2016-02-25 2020-02-04 Synaptive Medical (Barbados) Inc. System and method for automatic muscle movement detection
WO2017169135A1 (en) * 2016-03-30 2017-10-05 ソニー株式会社 Control device, control method, and operating microscope device
US10168688B2 (en) * 2016-04-29 2019-01-01 Taylor BRUSKY Systems and methods for implementing a pointer-guided tracking system and a pointer-guided mechanical movable device control system
CN113616332A (en) * 2016-05-23 2021-11-09 马科外科公司 System and method for identifying and tracking physical objects during robotic surgical procedures
US10265854B2 (en) 2016-08-04 2019-04-23 Synaptive Medical (Barbados) Inc. Operating room safety zone
WO2018032083A1 (en) * 2016-08-17 2018-02-22 Synaptive Medical (Barbados) Inc. Methods and systems for registration of virtual space with real space in an augmented reality system
CN109561934B (en) * 2016-08-23 2022-03-08 直观外科手术操作公司 System and method for monitoring patient motion during a medical procedure
US10993771B2 (en) * 2016-09-12 2021-05-04 Synaptive Medical Inc. Trackable apparatuses and methods
WO2018052795A1 (en) * 2016-09-19 2018-03-22 Intuitive Surgical Operations, Inc. Base positioning system for a controllable arm and related methods
CN109310474B (en) * 2016-09-19 2022-06-07 直观外科手术操作公司 Position indicator system for remotely controllable arm and related method
CN108135563B (en) * 2016-09-20 2021-12-03 桑托沙姆·罗伊 Light and shadow guided needle positioning system and method
CN106491087B (en) * 2016-10-28 2019-05-14 赵金 A kind of medical detection robot
US11607229B2 (en) 2016-12-08 2023-03-21 Orthotaxy S.A.S. Surgical system for cutting an anatomical structure according to at least one target plane
EP3551097B1 (en) * 2016-12-08 2024-03-20 Orthotaxy Surgical system for cutting an anatomical structure according to at least one target plane
EP3551098B1 (en) 2016-12-08 2024-03-20 Orthotaxy Surgical system for cutting an anatomical structure according to at least one target cutting plane
WO2018147930A1 (en) * 2017-02-08 2018-08-16 Intuitive Surgical Operations, Inc. Repositioning system for a remotely controllable manipulator and related methods
CN108066008B (en) * 2017-03-23 2020-05-29 深圳市罗伯医疗科技有限公司 Medical instrument control method and system for assisting operation
JP6903991B2 (en) 2017-03-27 2021-07-14 ソニーグループ株式会社 Surgical system, how to operate the surgical system and control device of the surgical system
US20180289432A1 (en) * 2017-04-05 2018-10-11 Kb Medical, Sa Robotic surgical systems for preparing holes in bone tissue and methods of their use
US10917543B2 (en) 2017-04-24 2021-02-09 Alcon Inc. Stereoscopic visualization camera and integrated robotics platform
EP3621542B1 (en) * 2017-05-09 2023-03-15 Brainlab AG Generation of augmented reality image of a medical device
US11141226B2 (en) * 2017-06-23 2021-10-12 Asensus Surgical Us, Inc. Method of graphically tagging and recalling identified structures under visualization for robotic surgery
CA2981726C (en) * 2017-10-06 2018-12-04 Synaptive Medical (Barbados) Inc. Surgical optical zoom system
CN107550569B (en) * 2017-10-16 2023-08-04 鹰利视医疗科技有限公司 Vertebra minimally invasive robot
US11911045B2 (en) 2017-10-30 2024-02-27 Cllag GmbH International Method for operating a powered articulating multi-clip applier
US11801098B2 (en) 2017-10-30 2023-10-31 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11229436B2 (en) 2017-10-30 2022-01-25 Cilag Gmbh International Surgical system comprising a surgical tool and a surgical hub
US20190125320A1 (en) 2017-10-30 2019-05-02 Ethicon Llc Control system arrangements for a modular surgical instrument
US11311342B2 (en) 2017-10-30 2022-04-26 Cilag Gmbh International Method for communicating with surgical instrument systems
US11564756B2 (en) 2017-10-30 2023-01-31 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11291510B2 (en) 2017-10-30 2022-04-05 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11123070B2 (en) 2017-10-30 2021-09-21 Cilag Gmbh International Clip applier comprising a rotatable clip magazine
US11510741B2 (en) 2017-10-30 2022-11-29 Cilag Gmbh International Method for producing a surgical instrument comprising a smart electrical system
US11317919B2 (en) 2017-10-30 2022-05-03 Cilag Gmbh International Clip applier comprising a clip crimping system
US11129679B2 (en) 2017-11-14 2021-09-28 Mako Surgical Corp. Fiber optic tracking system
CN107997822B (en) * 2017-12-06 2021-03-19 上海卓梦医疗科技有限公司 Minimally invasive surgery positioning system
CN108056756A (en) * 2017-12-09 2018-05-22 海宁神迹医疗器械有限公司 A kind of telescoping sensor type anaesthesia deepness monitoring instrument and its method of work
US11304720B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Activation of energy devices
US11160605B2 (en) 2017-12-28 2021-11-02 Cilag Gmbh International Surgical evacuation sensing and motor control
US11818052B2 (en) 2017-12-28 2023-11-14 Cilag Gmbh International Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs
US11179208B2 (en) 2017-12-28 2021-11-23 Cilag Gmbh International Cloud-based medical analytics for security and authentication trends and reactive measures
US11666331B2 (en) * 2017-12-28 2023-06-06 Cilag Gmbh International Systems for detecting proximity of surgical end effector to cancerous tissue
US11419630B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Surgical system distributed processing
US11308075B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Surgical network, instrument, and cloud responses based on validation of received dataset and authentication of its source and integrity
US11903601B2 (en) 2017-12-28 2024-02-20 Cilag Gmbh International Surgical instrument comprising a plurality of drive systems
US11147607B2 (en) 2017-12-28 2021-10-19 Cilag Gmbh International Bipolar combination device that automatically adjusts pressure based on energy modality
US11857152B2 (en) 2017-12-28 2024-01-02 Cilag Gmbh International Surgical hub spatial awareness to determine devices in operating theater
US11446052B2 (en) 2017-12-28 2022-09-20 Cilag Gmbh International Variation of radio frequency and ultrasonic power level in cooperation with varying clamp arm pressure to achieve predefined heat flux or power applied to tissue
US11376002B2 (en) 2017-12-28 2022-07-05 Cilag Gmbh International Surgical instrument cartridge sensor assemblies
US11324557B2 (en) 2017-12-28 2022-05-10 Cilag Gmbh International Surgical instrument with a sensing array
US11659023B2 (en) 2017-12-28 2023-05-23 Cilag Gmbh International Method of hub communication
US11389164B2 (en) 2017-12-28 2022-07-19 Cilag Gmbh International Method of using reinforced flexible circuits with multiple sensors to optimize performance of radio frequency devices
US11589888B2 (en) 2017-12-28 2023-02-28 Cilag Gmbh International Method for controlling smart energy devices
US11464559B2 (en) 2017-12-28 2022-10-11 Cilag Gmbh International Estimating state of ultrasonic end effector and control system therefor
US20190201146A1 (en) 2017-12-28 2019-07-04 Ethicon Llc Safety systems for smart powered surgical stapling
US11179175B2 (en) 2017-12-28 2021-11-23 Cilag Gmbh International Controlling an ultrasonic surgical instrument according to tissue location
US11304763B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Image capturing of the areas outside the abdomen to improve placement and control of a surgical device in use
US11278281B2 (en) 2017-12-28 2022-03-22 Cilag Gmbh International Interactive surgical system
US11284936B2 (en) 2017-12-28 2022-03-29 Cilag Gmbh International Surgical instrument having a flexible electrode
US10892995B2 (en) 2017-12-28 2021-01-12 Ethicon Llc Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs
US11771487B2 (en) 2017-12-28 2023-10-03 Cilag Gmbh International Mechanisms for controlling different electromechanical systems of an electrosurgical instrument
US11832899B2 (en) 2017-12-28 2023-12-05 Cilag Gmbh International Surgical systems with autonomously adjustable control programs
US11257589B2 (en) 2017-12-28 2022-02-22 Cilag Gmbh International Real-time analysis of comprehensive cost of all instrumentation used in surgery utilizing data fluidity to track instruments through stocking and in-house processes
US11844579B2 (en) 2017-12-28 2023-12-19 Cilag Gmbh International Adjustments based on airborne particle properties
US11291495B2 (en) 2017-12-28 2022-04-05 Cilag Gmbh International Interruption of energy due to inadvertent capacitive coupling
US11786245B2 (en) 2017-12-28 2023-10-17 Cilag Gmbh International Surgical systems with prioritized data transmission capabilities
US11559307B2 (en) 2017-12-28 2023-01-24 Cilag Gmbh International Method of robotic hub communication, detection, and control
US11364075B2 (en) 2017-12-28 2022-06-21 Cilag Gmbh International Radio frequency energy device for delivering combined electrical signals
US11571234B2 (en) 2017-12-28 2023-02-07 Cilag Gmbh International Temperature control of ultrasonic end effector and control system therefor
US11100631B2 (en) 2017-12-28 2021-08-24 Cilag Gmbh International Use of laser light and red-green-blue coloration to determine properties of back scattered light
US11786251B2 (en) 2017-12-28 2023-10-17 Cilag Gmbh International Method for adaptive control schemes for surgical network control and interaction
US11109866B2 (en) 2017-12-28 2021-09-07 Cilag Gmbh International Method for circular stapler control algorithm adjustment based on situational awareness
US11410259B2 (en) 2017-12-28 2022-08-09 Cilag Gmbh International Adaptive control program updates for surgical devices
US11672605B2 (en) 2017-12-28 2023-06-13 Cilag Gmbh International Sterile field interactive control displays
US11864728B2 (en) 2017-12-28 2024-01-09 Cilag Gmbh International Characterization of tissue irregularities through the use of mono-chromatic light refractivity
US11419667B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Ultrasonic energy device which varies pressure applied by clamp arm to provide threshold control pressure at a cut progression location
US20190200981A1 (en) 2017-12-28 2019-07-04 Ethicon Llc Method of compressing tissue within a stapling device and simultaneously displaying the location of the tissue within the jaws
US11304699B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Method for adaptive control schemes for surgical network control and interaction
US11602393B2 (en) 2017-12-28 2023-03-14 Cilag Gmbh International Surgical evacuation sensing and generator control
US11304745B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Surgical evacuation sensing and display
US11273001B2 (en) 2017-12-28 2022-03-15 Cilag Gmbh International Surgical hub and modular device response adjustment based on situational awareness
US11633237B2 (en) 2017-12-28 2023-04-25 Cilag Gmbh International Usage and technique analysis of surgeon / staff performance against a baseline to optimize device utilization and performance for both current and future procedures
US11132462B2 (en) 2017-12-28 2021-09-28 Cilag Gmbh International Data stripping method to interrogate patient records and create anonymized record
US11234756B2 (en) 2017-12-28 2022-02-01 Cilag Gmbh International Powered surgical tool with predefined adjustable control algorithm for controlling end effector parameter
US10758310B2 (en) 2017-12-28 2020-09-01 Ethicon Llc Wireless pairing of a surgical device with another device within a sterile surgical field based on the usage and situational awareness of devices
US11464535B2 (en) 2017-12-28 2022-10-11 Cilag Gmbh International Detection of end effector emersion in liquid
US11423007B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Adjustment of device control programs based on stratified contextual data in addition to the data
US11529187B2 (en) 2017-12-28 2022-12-20 Cilag Gmbh International Surgical evacuation sensor arrangements
US11213359B2 (en) * 2017-12-28 2022-01-04 Cilag Gmbh International Controllers for robot-assisted surgical platforms
US11166772B2 (en) 2017-12-28 2021-11-09 Cilag Gmbh International Surgical hub coordination of control and communication of operating room devices
US11056244B2 (en) 2017-12-28 2021-07-06 Cilag Gmbh International Automated data scaling, alignment, and organizing based on predefined parameters within surgical networks
US11311306B2 (en) 2017-12-28 2022-04-26 Cilag Gmbh International Surgical systems for detecting end effector tissue distribution irregularities
US11540855B2 (en) 2017-12-28 2023-01-03 Cilag Gmbh International Controlling activation of an ultrasonic surgical instrument according to the presence of tissue
US11317937B2 (en) 2018-03-08 2022-05-03 Cilag Gmbh International Determining the state of an ultrasonic end effector
US11744604B2 (en) 2017-12-28 2023-09-05 Cilag Gmbh International Surgical instrument with a hardware-only control circuit
US11424027B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Method for operating surgical instrument systems
US11253315B2 (en) 2017-12-28 2022-02-22 Cilag Gmbh International Increasing radio frequency to create pad-less monopolar loop
US11896322B2 (en) 2017-12-28 2024-02-13 Cilag Gmbh International Sensing the patient position and contact utilizing the mono-polar return pad electrode to provide situational awareness to the hub
US11432885B2 (en) 2017-12-28 2022-09-06 Cilag Gmbh International Sensing arrangements for robot-assisted surgical platforms
US11013563B2 (en) 2017-12-28 2021-05-25 Ethicon Llc Drive arrangements for robot-assisted surgical platforms
US11576677B2 (en) 2017-12-28 2023-02-14 Cilag Gmbh International Method of hub communication, processing, display, and cloud analytics
US11096693B2 (en) 2017-12-28 2021-08-24 Cilag Gmbh International Adjustment of staple height of at least one row of staples based on the sensed tissue thickness or force in closing
US11559308B2 (en) 2017-12-28 2023-01-24 Cilag Gmbh International Method for smart energy device infrastructure
US11266468B2 (en) 2017-12-28 2022-03-08 Cilag Gmbh International Cooperative utilization of data derived from secondary sources by intelligent surgical hubs
US11832840B2 (en) 2017-12-28 2023-12-05 Cilag Gmbh International Surgical instrument having a flexible circuit
US11896443B2 (en) 2017-12-28 2024-02-13 Cilag Gmbh International Control of a surgical system through a surgical barrier
US11678881B2 (en) 2017-12-28 2023-06-20 Cilag Gmbh International Spatial awareness of surgical hubs in operating rooms
US11202570B2 (en) 2017-12-28 2021-12-21 Cilag Gmbh International Communication hub and storage device for storing parameters and status of a surgical device to be shared with cloud based analytics systems
US10856890B2 (en) * 2018-02-02 2020-12-08 Orthosoft Ulc Robotic surgery planar cutting systems and methods
AU2019218707A1 (en) 2018-02-07 2020-08-13 Distalmotion Sa Surgical robot systems comprising robotic telemanipulators and integrated laparoscopy
JP6818708B2 (en) * 2018-02-28 2021-01-20 株式会社東芝 Manipulator systems, controls, control methods, and programs
US11259830B2 (en) 2018-03-08 2022-03-01 Cilag Gmbh International Methods for controlling temperature in ultrasonic device
US11337746B2 (en) 2018-03-08 2022-05-24 Cilag Gmbh International Smart blade and power pulsing
US11534196B2 (en) 2018-03-08 2022-12-27 Cilag Gmbh International Using spectroscopy to determine device use state in combo instrument
US11207067B2 (en) 2018-03-28 2021-12-28 Cilag Gmbh International Surgical stapling device with separate rotary driven closure and firing systems and firing member that engages both jaws while firing
US11278280B2 (en) 2018-03-28 2022-03-22 Cilag Gmbh International Surgical instrument comprising a jaw closure lockout
US11090047B2 (en) 2018-03-28 2021-08-17 Cilag Gmbh International Surgical instrument comprising an adaptive control system
US11589865B2 (en) 2018-03-28 2023-02-28 Cilag Gmbh International Methods for controlling a powered surgical stapler that has separate rotary closure and firing systems
US11219453B2 (en) 2018-03-28 2022-01-11 Cilag Gmbh International Surgical stapling devices with cartridge compatible closure and firing lockout arrangements
US11471156B2 (en) 2018-03-28 2022-10-18 Cilag Gmbh International Surgical stapling devices with improved rotary driven closure systems
US11166716B2 (en) 2018-03-28 2021-11-09 Cilag Gmbh International Stapling instrument comprising a deactivatable lockout
US11039894B2 (en) * 2018-04-20 2021-06-22 Verb Surgical Inc. Robotic port placement guide and method of use
DE102018206406B3 (en) * 2018-04-25 2019-09-12 Carl Zeiss Meditec Ag Microscopy system and method for operating a microscopy system
WO2019210322A1 (en) * 2018-04-27 2019-10-31 Truevision Systems, Inc. Stereoscopic visualization camera and integrated robotics platform
EP3569159A1 (en) * 2018-05-14 2019-11-20 Orthotaxy Surgical system for cutting an anatomical structure according to at least one target plane
US11291507B2 (en) 2018-07-16 2022-04-05 Mako Surgical Corp. System and method for image based registration and calibration
TWI733151B (en) * 2018-08-01 2021-07-11 鈦隼生物科技股份有限公司 Method, system and readable storage media of tracking patient position in operation
US20210268659A1 (en) * 2018-09-25 2021-09-02 Visual Robotics Systems Inc. Spatially-Aware Camera and Method Thereof
US11192253B2 (en) * 2018-10-12 2021-12-07 Toyota Research Institute, Inc. Systems and methods for conditional robotic teleoperation
CN109605344B (en) * 2019-01-09 2021-02-09 北京精密机电控制设备研究所 Multi-degree-of-freedom open-loop stepping series mechanical arm and control method thereof
US20220117680A1 (en) * 2019-01-14 2022-04-21 Intuitive Surgical Operations, Inc. System and method for automated docking
CN109549706B (en) * 2019-01-21 2023-12-22 华科精准(北京)医疗科技有限公司 Surgical operation auxiliary system and application method thereof
EP3696593A1 (en) * 2019-02-12 2020-08-19 Leica Instruments (Singapore) Pte. Ltd. A controller for a microscope, a corresponding method and a microscope system
US11369377B2 (en) 2019-02-19 2022-06-28 Cilag Gmbh International Surgical stapling assembly with cartridge based retainer configured to unlock a firing lockout
US11259807B2 (en) 2019-02-19 2022-03-01 Cilag Gmbh International Staple cartridges with cam surfaces configured to engage primary and secondary portions of a lockout of a surgical stapling device
US11317915B2 (en) 2019-02-19 2022-05-03 Cilag Gmbh International Universal cartridge based key feature that unlocks multiple lockout arrangements in different surgical staplers
US11357503B2 (en) 2019-02-19 2022-06-14 Cilag Gmbh International Staple cartridge retainers with frangible retention features and methods of using same
US11751872B2 (en) 2019-02-19 2023-09-12 Cilag Gmbh International Insertable deactivator element for surgical stapler lockouts
KR102269772B1 (en) * 2019-03-13 2021-06-28 큐렉소 주식회사 End effector for surgical robot
US20200297426A1 (en) * 2019-03-22 2020-09-24 Globus Medical, Inc. System for neuronavigation registration and robotic trajectory guidance, and related methods and devices
US10827162B1 (en) * 2019-04-15 2020-11-03 Synaptive Medical (Barbados) Inc. Augmented optical imaging system for use in medical procedures
WO2020243631A1 (en) * 2019-05-30 2020-12-03 Icahn School Of Medicine At Mount Sinai Robot mounted camera registration and tracking system for orthopedic and neurological surgery
US11504193B2 (en) * 2019-05-21 2022-11-22 Verb Surgical Inc. Proximity sensors for surgical robotic arm manipulation
US11278361B2 (en) 2019-05-21 2022-03-22 Verb Surgical Inc. Sensors for touch-free control of surgical robotic systems
JP7290472B2 (en) * 2019-05-29 2023-06-13 ファナック株式会社 robot system
EP3753521A1 (en) * 2019-06-19 2020-12-23 Karl Storz SE & Co. KG Medical handling device for controlling a handling device
USD952144S1 (en) 2019-06-25 2022-05-17 Cilag Gmbh International Surgical staple cartridge retainer with firing system authentication key
USD950728S1 (en) 2019-06-25 2022-05-03 Cilag Gmbh International Surgical staple cartridge
USD964564S1 (en) 2019-06-25 2022-09-20 Cilag Gmbh International Surgical staple cartridge retainer with a closure system authentication key
CN114007521A (en) * 2019-06-26 2022-02-01 奥瑞斯健康公司 System and method for robotic arm alignment and docking
US11413102B2 (en) 2019-06-27 2022-08-16 Cilag Gmbh International Multi-access port for surgical robotic systems
US11547468B2 (en) 2019-06-27 2023-01-10 Cilag Gmbh International Robotic surgical system with safety and cooperative sensing control
US11723729B2 (en) 2019-06-27 2023-08-15 Cilag Gmbh International Robotic surgical assembly coupling safety mechanisms
US11399906B2 (en) 2019-06-27 2022-08-02 Cilag Gmbh International Robotic surgical system for controlling close operation of end-effectors
US11612445B2 (en) * 2019-06-27 2023-03-28 Cilag Gmbh International Cooperative operation of robotic arms
US11607278B2 (en) 2019-06-27 2023-03-21 Cilag Gmbh International Cooperative robotic surgical systems
JP7186349B2 (en) * 2019-06-27 2022-12-09 パナソニックIpマネジメント株式会社 END EFFECTOR CONTROL SYSTEM AND END EFFECTOR CONTROL METHOD
CN110464571B (en) * 2019-08-01 2021-02-12 南通市第一人民医院 Clinical auxiliary treatment bed for burns or scalds and using method thereof
CN110613511B (en) * 2019-10-16 2021-03-16 武汉联影智融医疗科技有限公司 Obstacle avoidance method for surgical robot
CN111216109A (en) * 2019-10-22 2020-06-02 东北大学 Visual following device and method for clinical treatment and detection
CN113081269A (en) * 2020-01-08 2021-07-09 格罗伯斯医疗有限公司 Surgical robotic system for performing surgery on anatomical features of a patient
EP3851050A1 (en) * 2020-01-16 2021-07-21 Siemens Healthcare GmbH Mobile platform
CN111476882B (en) * 2020-03-26 2023-09-08 哈尔滨工业大学 Robot virtual graph modeling method oriented to browser
CN111407406B (en) * 2020-03-31 2022-04-26 武汉联影智融医疗科技有限公司 Head position identification system, intraoperative control system and control method
CN111700684A (en) * 2020-05-29 2020-09-25 武汉联影智融医疗科技有限公司 Rotating arm mechanism and integrated robot surgery platform
WO2022011538A1 (en) * 2020-07-14 2022-01-20 Covidien Lp Systems and methods for positioning access ports
CN112025705B (en) * 2020-08-26 2021-10-29 哈尔滨理工大学 Traditional Chinese medicine acupuncture system and method based on cooperative robot
USD993420S1 (en) * 2020-09-30 2023-07-25 Karl Storz Se & Co. Kg Robotic arm for exoscopes
CN112263332B (en) * 2020-10-23 2022-08-05 上海微创医疗机器人(集团)股份有限公司 System, method, medium, and terminal for adjusting surgical robot
CN112353495B (en) * 2020-10-29 2021-08-10 北京唯迈医疗设备有限公司 Intervene surgical robot arm system
CN112248008A (en) * 2020-11-09 2021-01-22 华北科技学院 Rescue robot and method for searching trapped people for fire fighting
CN113017857B (en) * 2021-02-25 2022-12-20 上海联影医疗科技股份有限公司 Positioning method, positioning device, computer equipment and storage medium
CN113040913A (en) * 2021-03-02 2021-06-29 上海微创医疗机器人(集团)股份有限公司 Mechanical arm, surgical device, surgical end device, surgical system and working method
CN112914729A (en) * 2021-03-25 2021-06-08 江苏集萃复合材料装备研究所有限公司 Intelligent auxiliary positioning bone surgery robot system and operation method thereof
CA3210584A1 (en) * 2021-03-29 2022-10-06 Patrick Terry Stereoscopic imaging platform with target locking automatic focusing mode
CA3210577A1 (en) * 2021-03-29 2022-10-06 Patrick Terry Stereoscopic imaging platform with disparity and sharpness control automatic focusing mode
DE102021134553A1 (en) 2021-12-23 2023-06-29 B. Braun New Ventures GmbH Robotic registration procedure and surgical navigation system
CN113954082B (en) * 2021-12-23 2022-03-08 真健康(北京)医疗科技有限公司 Control method, control equipment and auxiliary system suitable for puncture surgical mechanical arm
US20230278217A1 (en) * 2022-03-01 2023-09-07 Alcon Inc. Robotic imaging system with force-based collision avoidance mode
WO2023166384A1 (en) * 2022-03-01 2023-09-07 Alcon Inc. Robotic imaging system with velocity-based collision avoidance mode
US11844585B1 (en) 2023-02-10 2023-12-19 Distalmotion Sa Surgical robotics systems and devices having a sterile restart, and methods thereof

Citations (81)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4609814A (en) 1983-06-20 1986-09-02 Tokyo Kogaku Kikai Kabushiki Kaisha Control for operation microscopes
US5230338A (en) 1987-11-10 1993-07-27 Allen George S Interactive image-guided surgical system for displaying images corresponding to the placement of a surgical tool or the like
US5445166A (en) 1991-06-13 1995-08-29 International Business Machines Corporation System for advising a surgeon
US5696837A (en) 1994-05-05 1997-12-09 Sri International Method and apparatus for transforming coordinate systems in a telemanipulation system
US5792147A (en) 1994-03-17 1998-08-11 Roke Manor Research Ltd. Video-based systems for computer assisted surgery and localisation
US5876325A (en) * 1993-11-02 1999-03-02 Olympus Optical Co., Ltd. Surgical manipulation system
US5907664A (en) 1992-08-10 1999-05-25 Computer Motion, Inc. Automated endoscope system for optimal positioning
US6006127A (en) 1997-02-28 1999-12-21 U.S. Philips Corporation Image-guided surgery system
US6135946A (en) 1997-06-23 2000-10-24 U.S. Philips Corporation Method and system for image-guided interventional endoscopic procedures
US6351659B1 (en) 1995-09-28 2002-02-26 Brainlab Med. Computersysteme Gmbh Neuro-navigation system
US6441577B2 (en) 1998-08-04 2002-08-27 Intuitive Surgical, Inc. Manipulator positioning linkage for robotic surgery
US6468265B1 (en) 1998-11-20 2002-10-22 Intuitive Surgical, Inc. Performing cardiac surgery without cardioplegia
US6519359B1 (en) * 1999-10-28 2003-02-11 General Electric Company Range camera controller for acquiring 3D models
US6546279B1 (en) 2001-10-12 2003-04-08 University Of Florida Computer controlled guidance of a biopsy needle
US6663559B2 (en) 2001-12-14 2003-12-16 Endactive, Inc. Interface for a variable direction of view endoscope
US20040010190A1 (en) 2000-02-25 2004-01-15 The Board Of Trustees Of The Leland Stanford Junior University Methods and apparatuses for maintaining a trajectory in sterotaxi for tracking a target inside a body
US20040015053A1 (en) 2000-05-22 2004-01-22 Johannes Bieger Fully-automatic, robot-assisted camera guidance susing positions sensors for laparoscopic interventions
US6710320B2 (en) * 2000-09-18 2004-03-23 Olympus Optical Co., Ltd. Small sized imaging device which detects position information and image information
US6804581B2 (en) 1992-08-10 2004-10-12 Computer Motion, Inc. Automated endoscope system for optimal positioning
US20040210105A1 (en) 2003-04-21 2004-10-21 Hale Eric Lawrence Method for capturing and displaying endoscopic maps
US20050054895A1 (en) 2003-09-09 2005-03-10 Hoeg Hans David Method for using variable direction of view endoscopy in conjunction with image guided surgical systems
US20050096502A1 (en) * 2003-10-29 2005-05-05 Khalili Theodore M. Robotic surgical device
US6919867B2 (en) 2001-03-29 2005-07-19 Siemens Corporate Research, Inc. Method and apparatus for augmented reality visualization
US6933695B2 (en) 1999-08-03 2005-08-23 Intuitive Surgical Ceiling and floor mounted surgical robot set-up arms
US20050281385A1 (en) 2004-06-02 2005-12-22 Johnson Douglas K Method and system for improved correction of registration error in a fluoroscopic image
DE102004049258A1 (en) 2004-10-04 2006-04-06 Universität Tübingen Operation-supporting medical information system controlling device, has control unit with control unit section to evaluate indicating instrument positions and motion operation, where section produces control signal for information system
WO2006095027A1 (en) 2005-03-11 2006-09-14 Bracco Imaging S.P.A. Methods and apparati for surgical navigation and visualization with microscope
US20070088245A1 (en) * 2005-06-23 2007-04-19 Celleration, Inc. Removable applicator nozzle for ultrasound wound therapy device
US20080109026A1 (en) 2004-10-28 2008-05-08 Strategic Technology Assessment Group Apparatus and Methods for Performing Brain Surgery
US20080201016A1 (en) 2005-07-06 2008-08-21 Prosurgics Limited Robot and Method of Registering a Robot
WO2008115566A2 (en) 2007-03-20 2008-09-25 Peak Biosciences, Inc. Guidance and implantation of catheters
US20080243142A1 (en) 2007-02-20 2008-10-02 Gildenberg Philip L Videotactic and audiotactic assisted surgical methods and procedures
US20080262297A1 (en) 2004-04-26 2008-10-23 Super Dimension Ltd. System and Method for Image-Based Alignment of an Endoscope
US20090043248A1 (en) * 2007-01-04 2009-02-12 Celleration, Inc. Removable multi-channel applicator nozzle
US7491198B2 (en) 2003-04-28 2009-02-17 Bracco Imaging S.P.A. Computer enhanced surgical navigation imaging system (camera probe)
US20090048622A1 (en) 2004-10-28 2009-02-19 Wilson Jeffrey A Apparatus and methods for performing brain surgery
US20090245600A1 (en) 2008-03-28 2009-10-01 Intuitive Surgical, Inc. Automated panning and digital zooming for robotic surgical systems
US7607440B2 (en) 2001-06-07 2009-10-27 Intuitive Surgical, Inc. Methods and apparatus for surgical planning
US20100094085A1 (en) 2007-01-31 2010-04-15 National University Corporation Hamamatsu Universi Ty School Of Medicine Device for Displaying Assistance Information for Surgical Operation, Method for Displaying Assistance Information for Surgical Operation, and Program for Displaying Assistance Information for Surgical Operation
US20100135534A1 (en) * 2007-08-17 2010-06-03 Renishaw Plc Non-contact probe
US20100168518A1 (en) 2007-02-23 2010-07-01 Universite De Strasbourg Flexible endoscope device with visual control and process for stabilization of such a device
US20100198402A1 (en) * 2007-04-16 2010-08-05 Alexander Greer Methods, devices, and systems for non-mechanically restricting and/or programming movement of a tool of a manipulator along a single axis
EP0947287B1 (en) 1998-03-31 2010-09-15 Nidek Co., Ltd. An eyeglass lens processing system and an eyeglass lens processing preparation system
US7892224B2 (en) 2005-06-01 2011-02-22 Brainlab Ag Inverse catheter planning
US7892165B2 (en) 2006-10-23 2011-02-22 Hoya Corporation Camera calibration for endoscope navigation system
EP1599148B1 (en) 2003-02-25 2011-04-20 Medtronic Image-Guided Neurologics, Inc. Fiducial marker devices
WO2011058530A1 (en) 2009-11-16 2011-05-19 Koninklijke Philips Electronics, N.V. Human-robot shared control for endoscopic assistant robot
US20110162476A1 (en) 2008-06-12 2011-07-07 Mitaka Kohki Co., Ltd. Holding Arm Apparatus for Medical Tool
US8010181B2 (en) 2006-02-16 2011-08-30 Catholic Healthcare West System utilizing radio frequency signals for tracking and improving navigation of slender instruments during insertion in the body
WO2011149187A2 (en) 2010-05-25 2011-12-01 Jeong Chang Wook Surgical robot system for realizing single-port surgery and multi-port surgery and method for controlling same
US8073528B2 (en) 2007-09-30 2011-12-06 Intuitive Surgical Operations, Inc. Tool tracking systems, methods and computer products for image guided surgery
WO2011156733A2 (en) 2010-06-11 2011-12-15 Angiotech Pharmaceuticals, Inc. Suture delivery tools for endoscopic and robot-assisted surgery and methods
US20120066887A1 (en) 2010-09-22 2012-03-22 Itt Manufacturing Enterprises, Inc. Method of aligning an imaging device in an optical system
US20120071748A1 (en) 2004-10-28 2012-03-22 Mark Joseph L Surgical access assembly and method of using same
US20120083661A1 (en) 2010-10-01 2012-04-05 Tyco Healthcare Group Lp Access port
US20120147359A9 (en) 2000-10-11 2012-06-14 Stetten George De Witt Combining tomographic images in situ with direct vision in sterile environments
WO2012098485A1 (en) 2011-01-20 2012-07-26 Koninklijke Philips Electronics N.V. Method for determining at least one applicable path of movement for an object in tissue
US20120253375A1 (en) 2004-10-28 2012-10-04 Mark Joseph L Surgical access assembly and method of using same
US20120265060A1 (en) 2007-06-19 2012-10-18 Sankaralingam Ramraj Target location by tracking of imaging device
US20120265071A1 (en) 2011-03-22 2012-10-18 Kuka Laboratories Gmbh Medical Workstation
US20120265023A1 (en) 2011-04-18 2012-10-18 George Berci Exoscope
US20120296198A1 (en) 2005-09-30 2012-11-22 Robinson Joseph P Endoscopic imaging device
US8335557B2 (en) 2006-12-22 2012-12-18 Siemens Aktiengesellschaft System for carrying out and monitoring minimally-invasive interventions
US20130053866A1 (en) * 2011-08-24 2013-02-28 The Chinese University Of Hong Kong Surgical robot with hybrid passive/active control
US20130053648A1 (en) 2011-08-24 2013-02-28 Mako Surgical Corporation Surgical Tool for Selectively Illuminating a Surgical Volume
US8396598B2 (en) 2002-08-13 2013-03-12 Neuroarm Surgical Ltd. Microsurgical robot system
EP2567668A1 (en) 2011-09-08 2013-03-13 Stryker Leibinger GmbH & Co. KG Axial surgical trajectory guide for guiding a medical device
US20130066335A1 (en) 2010-05-25 2013-03-14 Ronny Bärwinkel Method for moving an instrument arm of a laparoscopy robot into a predeterminable relative position with respect to a trocar
US8400094B2 (en) 2007-12-21 2013-03-19 Intuitive Surgical Operations, Inc. Robotic surgical system with patient support
US8398541B2 (en) 2006-06-06 2013-03-19 Intuitive Surgical Operations, Inc. Interactive user interfaces for robotic minimally invasive surgical systems
US8414475B2 (en) 2005-04-18 2013-04-09 M.S.T. Medical Surgery Technologies Ltd Camera holder device and method thereof
US20130094742A1 (en) 2010-07-14 2013-04-18 Thomas Feilkas Method and system for determining an imaging direction and calibration of an imaging apparatus
US20130102886A1 (en) 2011-10-24 2013-04-25 Joseph L. Mark Surgical access system with navigation element and method of using same
US8439830B2 (en) 2009-03-27 2013-05-14 EndoSphere Surgical, Inc. Cannula with integrated camera and illumination
US20130158565A1 (en) * 2009-11-27 2013-06-20 Mcmaster University Automated in-bore mr guided robotic diagnostic and therapeutic system
US20130204095A1 (en) 2004-10-28 2013-08-08 Nico Corporation Surgical access assembly and method of using same
US20130204287A1 (en) 2004-10-28 2013-08-08 Nico Corporation Surgical access assembly and method of using same
US20130303883A1 (en) 2012-05-14 2013-11-14 Mazor Robotics Ltd. Robotic guided endoscope
US8624537B2 (en) 2005-05-19 2014-01-07 Intuitive Surgical Operations, Inc. Software center and highly configurable robotic systems for surgery and other uses
US20140171873A1 (en) 2012-12-17 2014-06-19 Nico Corporation Surgical access system
US20140357953A1 (en) * 2010-06-24 2014-12-04 Hansen Medical, Inc. Methods and devices for controlling a shapeable medical device

Family Cites Families (19)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6628711B1 (en) 1999-07-02 2003-09-30 Motorola, Inc. Method and apparatus for compensating for jitter in a digital video image
GB0222265D0 (en) * 2002-09-25 2002-10-30 Imp College Innovations Ltd Control of robotic manipulation
US7066879B2 (en) * 2003-07-15 2006-06-27 The Trustees Of Columbia University In The City Of New York Insertable device and system for minimal access procedure
DE102004011460B4 (en) * 2004-03-09 2011-07-14 Siemens AG, 80333 C-arm device with weight compensation
US20070161876A1 (en) * 2005-11-18 2007-07-12 Spectrx, Inc. Method and apparatus for rapid detection and diagnosis of tissue abnormalities
CN101448468B (en) 2006-05-19 2011-10-12 马科外科公司 System and method for verifying calibration of a surgical device
US8444631B2 (en) * 2007-06-14 2013-05-21 Macdonald Dettwiler & Associates Inc Surgical manipulator
US20100198101A1 (en) * 2007-09-24 2010-08-05 Xubo Song Non-invasive location and tracking of tumors and other tissues for radiation therapy
US20100042020A1 (en) * 2008-08-13 2010-02-18 Shmuel Ben-Ezra Focused energy delivery apparatus method and system
JP4751963B2 (en) * 2009-03-10 2011-08-17 オリンパスメディカルシステムズ株式会社 Position detection system and method of operating position detection system
US8935003B2 (en) * 2010-09-21 2015-01-13 Intuitive Surgical Operations Method and system for hand presence detection in a minimally invasive surgical system
US8601897B2 (en) * 2009-11-30 2013-12-10 GM Global Technology Operations LLC Force limiting device and method
US9516207B2 (en) * 2010-06-24 2016-12-06 Marc S. Lemchen Exam-cam robotic systems and methods
US8369483B2 (en) * 2010-09-07 2013-02-05 William Eugene Campbell Multi-resolution X-ray image capture
US20130085510A1 (en) * 2011-09-30 2013-04-04 Ethicon Endo-Surgery, Inc. Robot-mounted surgical tables
US20140135791A1 (en) * 2012-11-09 2014-05-15 Blue Belt Technologies, Inc. Systems and methods for navigation and control of an implant positioning device
EP2967348B1 (en) * 2013-03-15 2022-03-23 Synaptive Medical Inc. Intelligent positioning system
US9990776B2 (en) * 2014-03-14 2018-06-05 Synaptive Medical (Barbados) Inc. System and method for projected tool trajectories for surgical navigation systems
US10675094B2 (en) * 2017-07-21 2020-06-09 Globus Medical Inc. Robot surgical platform

Patent Citations (86)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4609814A (en) 1983-06-20 1986-09-02 Tokyo Kogaku Kikai Kabushiki Kaisha Control for operation microscopes
US5230338A (en) 1987-11-10 1993-07-27 Allen George S Interactive image-guided surgical system for displaying images corresponding to the placement of a surgical tool or the like
US5445166A (en) 1991-06-13 1995-08-29 International Business Machines Corporation System for advising a surgeon
US5630431A (en) 1991-06-13 1997-05-20 International Business Machines Corporation System and method for augmentation of surgery
US6804581B2 (en) 1992-08-10 2004-10-12 Computer Motion, Inc. Automated endoscope system for optimal positioning
US5907664A (en) 1992-08-10 1999-05-25 Computer Motion, Inc. Automated endoscope system for optimal positioning
US5876325A (en) * 1993-11-02 1999-03-02 Olympus Optical Co., Ltd. Surgical manipulation system
US5792147A (en) 1994-03-17 1998-08-11 Roke Manor Research Ltd. Video-based systems for computer assisted surgery and localisation
US5696837A (en) 1994-05-05 1997-12-09 Sri International Method and apparatus for transforming coordinate systems in a telemanipulation system
US6351659B1 (en) 1995-09-28 2002-02-26 Brainlab Med. Computersysteme Gmbh Neuro-navigation system
US6006127A (en) 1997-02-28 1999-12-21 U.S. Philips Corporation Image-guided surgery system
US6135946A (en) 1997-06-23 2000-10-24 U.S. Philips Corporation Method and system for image-guided interventional endoscopic procedures
EP0947287B1 (en) 1998-03-31 2010-09-15 Nidek Co., Ltd. An eyeglass lens processing system and an eyeglass lens processing preparation system
US6441577B2 (en) 1998-08-04 2002-08-27 Intuitive Surgical, Inc. Manipulator positioning linkage for robotic surgery
US6468265B1 (en) 1998-11-20 2002-10-22 Intuitive Surgical, Inc. Performing cardiac surgery without cardioplegia
US6933695B2 (en) 1999-08-03 2005-08-23 Intuitive Surgical Ceiling and floor mounted surgical robot set-up arms
US6519359B1 (en) * 1999-10-28 2003-02-11 General Electric Company Range camera controller for acquiring 3D models
US20040010190A1 (en) 2000-02-25 2004-01-15 The Board Of Trustees Of The Leland Stanford Junior University Methods and apparatuses for maintaining a trajectory in sterotaxi for tracking a target inside a body
US20040015053A1 (en) 2000-05-22 2004-01-22 Johannes Bieger Fully-automatic, robot-assisted camera guidance susing positions sensors for laparoscopic interventions
US6710320B2 (en) * 2000-09-18 2004-03-23 Olympus Optical Co., Ltd. Small sized imaging device which detects position information and image information
US20120147359A9 (en) 2000-10-11 2012-06-14 Stetten George De Witt Combining tomographic images in situ with direct vision in sterile environments
US6919867B2 (en) 2001-03-29 2005-07-19 Siemens Corporate Research, Inc. Method and apparatus for augmented reality visualization
US7607440B2 (en) 2001-06-07 2009-10-27 Intuitive Surgical, Inc. Methods and apparatus for surgical planning
US8571710B2 (en) 2001-06-07 2013-10-29 Intuitive Surgical Operations, Inc. Methods and apparatus for surgical planning
US6546279B1 (en) 2001-10-12 2003-04-08 University Of Florida Computer controlled guidance of a biopsy needle
US6663559B2 (en) 2001-12-14 2003-12-16 Endactive, Inc. Interface for a variable direction of view endoscope
US8396598B2 (en) 2002-08-13 2013-03-12 Neuroarm Surgical Ltd. Microsurgical robot system
EP1599148B1 (en) 2003-02-25 2011-04-20 Medtronic Image-Guided Neurologics, Inc. Fiducial marker devices
US20040210105A1 (en) 2003-04-21 2004-10-21 Hale Eric Lawrence Method for capturing and displaying endoscopic maps
US7491198B2 (en) 2003-04-28 2009-02-17 Bracco Imaging S.P.A. Computer enhanced surgical navigation imaging system (camera probe)
US20050054895A1 (en) 2003-09-09 2005-03-10 Hoeg Hans David Method for using variable direction of view endoscopy in conjunction with image guided surgical systems
US20050096502A1 (en) * 2003-10-29 2005-05-05 Khalili Theodore M. Robotic surgical device
US20080262297A1 (en) 2004-04-26 2008-10-23 Super Dimension Ltd. System and Method for Image-Based Alignment of an Endoscope
US20050281385A1 (en) 2004-06-02 2005-12-22 Johnson Douglas K Method and system for improved correction of registration error in a fluoroscopic image
DE102004049258A1 (en) 2004-10-04 2006-04-06 Universität Tübingen Operation-supporting medical information system controlling device, has control unit with control unit section to evaluate indicating instrument positions and motion operation, where section produces control signal for information system
US20120071748A1 (en) 2004-10-28 2012-03-22 Mark Joseph L Surgical access assembly and method of using same
US20120289816A1 (en) 2004-10-28 2012-11-15 Mark Joseph L Surgical access assembly and method of using same
US20130204095A1 (en) 2004-10-28 2013-08-08 Nico Corporation Surgical access assembly and method of using same
US20130204287A1 (en) 2004-10-28 2013-08-08 Nico Corporation Surgical access assembly and method of using same
US20130102851A1 (en) 2004-10-28 2013-04-25 Joseph L. Mark Holding arrangement for a surgical access system
US20120253375A1 (en) 2004-10-28 2012-10-04 Mark Joseph L Surgical access assembly and method of using same
US20090048622A1 (en) 2004-10-28 2009-02-19 Wilson Jeffrey A Apparatus and methods for performing brain surgery
US20080109026A1 (en) 2004-10-28 2008-05-08 Strategic Technology Assessment Group Apparatus and Methods for Performing Brain Surgery
WO2006095027A1 (en) 2005-03-11 2006-09-14 Bracco Imaging S.P.A. Methods and apparati for surgical navigation and visualization with microscope
US8414475B2 (en) 2005-04-18 2013-04-09 M.S.T. Medical Surgery Technologies Ltd Camera holder device and method thereof
US8624537B2 (en) 2005-05-19 2014-01-07 Intuitive Surgical Operations, Inc. Software center and highly configurable robotic systems for surgery and other uses
US7892224B2 (en) 2005-06-01 2011-02-22 Brainlab Ag Inverse catheter planning
US20070088245A1 (en) * 2005-06-23 2007-04-19 Celleration, Inc. Removable applicator nozzle for ultrasound wound therapy device
US20080201016A1 (en) 2005-07-06 2008-08-21 Prosurgics Limited Robot and Method of Registering a Robot
US20120296198A1 (en) 2005-09-30 2012-11-22 Robinson Joseph P Endoscopic imaging device
US8010181B2 (en) 2006-02-16 2011-08-30 Catholic Healthcare West System utilizing radio frequency signals for tracking and improving navigation of slender instruments during insertion in the body
US8398541B2 (en) 2006-06-06 2013-03-19 Intuitive Surgical Operations, Inc. Interactive user interfaces for robotic minimally invasive surgical systems
US7892165B2 (en) 2006-10-23 2011-02-22 Hoya Corporation Camera calibration for endoscope navigation system
US8335557B2 (en) 2006-12-22 2012-12-18 Siemens Aktiengesellschaft System for carrying out and monitoring minimally-invasive interventions
US20090043248A1 (en) * 2007-01-04 2009-02-12 Celleration, Inc. Removable multi-channel applicator nozzle
US20100094085A1 (en) 2007-01-31 2010-04-15 National University Corporation Hamamatsu Universi Ty School Of Medicine Device for Displaying Assistance Information for Surgical Operation, Method for Displaying Assistance Information for Surgical Operation, and Program for Displaying Assistance Information for Surgical Operation
US20080243142A1 (en) 2007-02-20 2008-10-02 Gildenberg Philip L Videotactic and audiotactic assisted surgical methods and procedures
US20100168518A1 (en) 2007-02-23 2010-07-01 Universite De Strasbourg Flexible endoscope device with visual control and process for stabilization of such a device
WO2008115566A2 (en) 2007-03-20 2008-09-25 Peak Biosciences, Inc. Guidance and implantation of catheters
US20100198402A1 (en) * 2007-04-16 2010-08-05 Alexander Greer Methods, devices, and systems for non-mechanically restricting and/or programming movement of a tool of a manipulator along a single axis
US20120265060A1 (en) 2007-06-19 2012-10-18 Sankaralingam Ramraj Target location by tracking of imaging device
US20100135534A1 (en) * 2007-08-17 2010-06-03 Renishaw Plc Non-contact probe
US8073528B2 (en) 2007-09-30 2011-12-06 Intuitive Surgical Operations, Inc. Tool tracking systems, methods and computer products for image guided surgery
US8400094B2 (en) 2007-12-21 2013-03-19 Intuitive Surgical Operations, Inc. Robotic surgical system with patient support
US20090245600A1 (en) 2008-03-28 2009-10-01 Intuitive Surgical, Inc. Automated panning and digital zooming for robotic surgical systems
US20110162476A1 (en) 2008-06-12 2011-07-07 Mitaka Kohki Co., Ltd. Holding Arm Apparatus for Medical Tool
US8439830B2 (en) 2009-03-27 2013-05-14 EndoSphere Surgical, Inc. Cannula with integrated camera and illumination
WO2011058530A1 (en) 2009-11-16 2011-05-19 Koninklijke Philips Electronics, N.V. Human-robot shared control for endoscopic assistant robot
US20130158565A1 (en) * 2009-11-27 2013-06-20 Mcmaster University Automated in-bore mr guided robotic diagnostic and therapeutic system
US20130144307A1 (en) 2010-05-25 2013-06-06 Chang Wook Jeong Surgical robot system for realizing single-port surgery and multi-port surgery and method for controlling same
WO2011149187A2 (en) 2010-05-25 2011-12-01 Jeong Chang Wook Surgical robot system for realizing single-port surgery and multi-port surgery and method for controlling same
US20130066335A1 (en) 2010-05-25 2013-03-14 Ronny Bärwinkel Method for moving an instrument arm of a laparoscopy robot into a predeterminable relative position with respect to a trocar
WO2011156733A2 (en) 2010-06-11 2011-12-15 Angiotech Pharmaceuticals, Inc. Suture delivery tools for endoscopic and robot-assisted surgery and methods
US20140357953A1 (en) * 2010-06-24 2014-12-04 Hansen Medical, Inc. Methods and devices for controlling a shapeable medical device
US20130094742A1 (en) 2010-07-14 2013-04-18 Thomas Feilkas Method and system for determining an imaging direction and calibration of an imaging apparatus
US20120066887A1 (en) 2010-09-22 2012-03-22 Itt Manufacturing Enterprises, Inc. Method of aligning an imaging device in an optical system
US20120083661A1 (en) 2010-10-01 2012-04-05 Tyco Healthcare Group Lp Access port
WO2012098485A1 (en) 2011-01-20 2012-07-26 Koninklijke Philips Electronics N.V. Method for determining at least one applicable path of movement for an object in tissue
US20120265071A1 (en) 2011-03-22 2012-10-18 Kuka Laboratories Gmbh Medical Workstation
US20120265023A1 (en) 2011-04-18 2012-10-18 George Berci Exoscope
US20130053866A1 (en) * 2011-08-24 2013-02-28 The Chinese University Of Hong Kong Surgical robot with hybrid passive/active control
US20130053648A1 (en) 2011-08-24 2013-02-28 Mako Surgical Corporation Surgical Tool for Selectively Illuminating a Surgical Volume
EP2567668A1 (en) 2011-09-08 2013-03-13 Stryker Leibinger GmbH & Co. KG Axial surgical trajectory guide for guiding a medical device
US20130102886A1 (en) 2011-10-24 2013-04-25 Joseph L. Mark Surgical access system with navigation element and method of using same
US20130303883A1 (en) 2012-05-14 2013-11-14 Mazor Robotics Ltd. Robotic guided endoscope
US20140171873A1 (en) 2012-12-17 2014-06-19 Nico Corporation Surgical access system

Non-Patent Citations (14)

* Cited by examiner, † Cited by third party
Title
"Endoscope Microscopy", Karl Storz Brochure, Aug. 2012.
"Karl Storz VITOM® HD", Karl Storz Brochure, Oct. 2010.
Choi, Dong-Geol, Byung-Ju Yi, and Whee-kuk Kim. "Automation of Surgical Illumination System Using Robot and Ultrasonic Sensor." Mechatronics and Automation, 2007. ICMA 2007. International Conference on. IEEE, 2007.
European Search Report from EP2967348 dated Jan. 11, 2017.
Hurteau, R., et al. "Laparoscopic surgery assisted by a robotic cameraman: concept and experimental results." Robotics and Automation, 1994. Proceedings., 1994 IEEE International Conference on. IEEE, 1994.
International Preliminary Report on Patentability (PCT/CA2014/050271) dated Jun. 8, 2015.
International Search Report ( PCT /CA2014/050271) dated Jul. 17, 2014.
Lee, Cheolwhan, et al. "Image analysis for automated tracking in robot-assisted endoscopic surgery." Pattern Recognition, 1994. vol. 1-Conference A: Computer Vision Image Processing., Proceedings of the 12th IAPR International Conference on. vol. 1. IEEE, 1994.
Lee, Cheolwhan, et al. "Image analysis for automated tracking in robot-assisted endoscopic surgery." Pattern Recognition, 1994. vol. 1—Conference A: Computer Vision Image Processing., Proceedings of the 12th IAPR International Conference on. vol. 1. IEEE, 1994.
Mamelak, Adam N., et al. "A high-definition exoscope system for neurosurgery and other microsurgical disciplines: preliminary report." Surgical innovation 15.1 (2008): 38-46.
McLaughlin, Nancy, et al. "Endoneurosurgical resection of intraventricular and intraparenchymal lesions using the port technique." World neurosurgery 79.2 (2013): S18-e1.
Raczkowsky, Jörg, et al. "System Concept for Collision-Free Robot Assisted Surgery Using Real-Time Sensing." Intelligent Autonomous Systems 12. Springer Berlin Heidelberg, 2013. 165-173.
Written Opinion (PCT/CA2014/050271) dated Jul. 17, 2014.
Zudilova, Elena V. "A multi-modal interface for an interactive simulated vascular reconstruction system." Proceedings of the 4th IEEE International Conference on Multimodal Interfaces. IEEE Computer Society, 2002.

Cited By (38)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9828433B2 (en) 2010-11-15 2017-11-28 Novartis Ag Nucleic acids encoding silent Fc variants of anti-CD40 antibodies
US10323096B2 (en) 2010-11-15 2019-06-18 Novartis Ag Nucleic acids encoding silent Fc variants of anti-CD40 antibodies
US11124578B2 (en) 2010-11-15 2021-09-21 Novartis Ag Method of treating transplant rejection with silent Fc variants of anti-CD40 antibodies
US10136954B2 (en) * 2012-06-21 2018-11-27 Globus Medical, Inc. Surgical tool systems and method
US11207099B2 (en) * 2013-03-15 2021-12-28 Synaptive Medical Inc. Intelligent positioning system and methods therefor
US11103279B2 (en) * 2013-03-15 2021-08-31 Synaptive Medical Inc. Intelligent positioning system and methods therefor
US20170252921A1 (en) * 2014-11-25 2017-09-07 Kai HYNNA Hand-guided automated positioning device controller
US9914211B2 (en) * 2014-11-25 2018-03-13 Synaptive Medical (Barbados) Inc. Hand-guided automated positioning device controller
US10130435B2 (en) * 2014-12-23 2018-11-20 Siemens Aktiengesellschaft Operating a medical-robotic device and a medical-robotic device
US20160199141A1 (en) * 2014-12-23 2016-07-14 Philip Mewes Operating a medical-robotic device and a medical-robotic device
US11065069B2 (en) 2017-05-10 2021-07-20 Mako Surgical Corp. Robotic spine surgery system and methods
US11033341B2 (en) 2017-05-10 2021-06-15 Mako Surgical Corp. Robotic spine surgery system and methods
US11701188B2 (en) 2017-05-10 2023-07-18 Mako Surgical Corp. Robotic spine surgery system and methods
US10798321B2 (en) 2017-08-15 2020-10-06 Dolby Laboratories Licensing Corporation Bit-depth efficient image processing
US20230063233A1 (en) * 2017-08-25 2023-03-02 Novasignal Corp. Portable headset
US11338445B2 (en) * 2017-08-28 2022-05-24 Macdonald, Dettwiler And Associates Inc. End effector force sensor and manual actuation assistance
US11744670B2 (en) 2018-01-17 2023-09-05 Auris Health, Inc. Surgical platform with adjustable arm supports
US11114199B2 (en) 2018-01-25 2021-09-07 Mako Surgical Corp. Workflow systems and methods for enhancing collaboration between participants in a surgical procedure
US11850010B2 (en) 2018-01-25 2023-12-26 Mako Surgical Corp. Workflow systems and methods for enhancing collaboration between participants in a surgical procedure
DE102018205758A1 (en) * 2018-04-16 2019-10-17 Siemens Healthcare Gmbh Medical device and method for operating a medical device
US11197728B2 (en) 2018-09-17 2021-12-14 Auris Health, Inc. Systems and methods for concomitant medical procedures
US11903661B2 (en) 2018-09-17 2024-02-20 Auris Health, Inc. Systems and methods for concomitant medical procedures
US11602402B2 (en) 2018-12-04 2023-03-14 Globus Medical, Inc. Drill guide fixtures, cranial insertion fixtures, and related methods and robotic systems
US11254009B2 (en) 2018-12-20 2022-02-22 Auris Health, Inc. Systems and methods for robotic arm alignment and docking
WO2020131186A1 (en) * 2018-12-20 2020-06-25 Auris Health, Inc. Systems and methods for robotic arm alignment and docking
US11801605B2 (en) 2018-12-20 2023-10-31 Auris Health, Inc. Systems and methods for robotic arm alignment and docking
US11857277B2 (en) 2019-02-08 2024-01-02 Auris Health, Inc. Robotically controlled clot manipulation and removal
US11369448B2 (en) 2019-04-08 2022-06-28 Auris Health, Inc. Systems, methods, and workflows for concomitant procedures
US11234780B2 (en) 2019-09-10 2022-02-01 Auris Health, Inc. Systems and methods for kinematic optimization with shared robotic degrees-of-freedom
US11771510B2 (en) 2019-09-10 2023-10-03 Auris Health, Inc. Systems and methods for kinematic optimization with shared robotic degrees-of-freedom
US11701187B2 (en) 2019-09-26 2023-07-18 Auris Health, Inc. Systems and methods for collision detection and avoidance
US10959792B1 (en) 2019-09-26 2021-03-30 Auris Health, Inc. Systems and methods for collision detection and avoidance
US11660147B2 (en) 2019-12-31 2023-05-30 Auris Health, Inc. Alignment techniques for percutaneous access
US11602372B2 (en) 2019-12-31 2023-03-14 Auris Health, Inc. Alignment interfaces for percutaneous access
US11298195B2 (en) 2019-12-31 2022-04-12 Auris Health, Inc. Anatomical feature identification and targeting
US11839969B2 (en) 2020-06-29 2023-12-12 Auris Health, Inc. Systems and methods for detecting contact between a link and an external object
US11357586B2 (en) 2020-06-30 2022-06-14 Auris Health, Inc. Systems and methods for saturated robotic movement
US11931901B2 (en) 2021-06-23 2024-03-19 Auris Health, Inc. Robotic medical system with collision proximity indicators

Also Published As

Publication number Publication date
HK1216706A1 (en) 2016-12-02
CN105050527B (en) 2018-03-27
EP2967348A4 (en) 2017-02-08
CA2896381C (en) 2017-01-10
US20160113728A1 (en) 2016-04-28
US11103279B2 (en) 2021-08-31
CA2896381A1 (en) 2014-09-18
EP2967348A1 (en) 2016-01-20
US11207099B2 (en) 2021-12-28
BR112015023547B8 (en) 2022-09-27
US20170273715A1 (en) 2017-09-28
EP2967348B1 (en) 2022-03-23
AU2014231345A1 (en) 2015-11-05
WO2014139023A1 (en) 2014-09-18
SG11201507613QA (en) 2015-10-29
CA2939262A1 (en) 2015-09-17
BR112015023547A2 (en) 2017-07-18
BR112015023547B1 (en) 2022-01-18
AU2014231345B2 (en) 2019-01-17
US20220087711A1 (en) 2022-03-24
MY170323A (en) 2019-07-17
CA2939262C (en) 2017-09-12
CN105050527A (en) 2015-11-11
US20180177523A1 (en) 2018-06-28
CA2962015A1 (en) 2015-09-17

Similar Documents

Publication Publication Date Title
US20220087711A1 (en) Intelligent positioning system and methods therefore
US10588699B2 (en) Intelligent positioning system and methods therefore
US20230363833A1 (en) Methods And Systems For Robot-Assisted Surgery
US11844574B2 (en) Patient-specific preoperative planning simulation techniques
KR102623373B1 (en) System and method for integrated surgical table motion
KR102218244B1 (en) Collision avoidance during controlled movement of image capturing device and manipulatable device movable arms
JP2023002737A (en) Method and system for guiding user positioning robot
US20210228282A1 (en) Methods of guiding manual movement of medical systems
CA3141156A1 (en) A system and method for interaction and definition of tool pathways for a robotic cutting tool
CA2948719A1 (en) Intelligent positioning system and methods therefore

Legal Events

Date Code Title Description
AS Assignment

Owner name: SYNAPTIVE MEDICAL (BARBADOS) INC., BARBADOS

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:PIRON, CAMERON;WOOD, MICHAEL;SELA, GAL;AND OTHERS;REEL/FRAME:035967/0531

Effective date: 20140624

FEPP Fee payment procedure

Free format text: PAYOR NUMBER ASSIGNED (ORIGINAL EVENT CODE: ASPN); ENTITY STATUS OF PATENT OWNER: SMALL ENTITY

STCF Information on status: patent grant

Free format text: PATENTED CASE

MAFP Maintenance fee payment

Free format text: PAYMENT OF MAINTENANCE FEE, 4TH YR, SMALL ENTITY (ORIGINAL EVENT CODE: M2551); ENTITY STATUS OF PATENT OWNER: SMALL ENTITY

Year of fee payment: 4

AS Assignment

Owner name: SYNAPTIVE MEDICAL INC., CANADA

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:SYNAPTIVE MEDICAL (BARBADOS) INC.;REEL/FRAME:054251/0337

Effective date: 20200902

AS Assignment

Owner name: SYNAPTIVE MEDICAL INC., CANADA

Free format text: CORRECTIVE ASSIGNMENT TO CORRECT THE 16/935440 APPLICATION PREVIOUSLY RECORDED ON REEL 054251 FRAME 0337. ASSIGNOR(S) HEREBY CONFIRMS THE ASSIGNMENT;ASSIGNOR:SYNAPTIVE MEDICAL (BARBADOS) INC.;REEL/FRAME:055059/0725

Effective date: 20200902

AS Assignment

Owner name: ESPRESSO CAPITAL LTD., CANADA

Free format text: SECURITY INTEREST;ASSIGNOR:SYNAPTIVE MEDICAL INC.;REEL/FRAME:054922/0791

Effective date: 20201223